1Nord J Psychiatry 2002 -1 56: 175-9
PMID12079568
TitleDrop-out and continuity of care for patients suffering from schizophrenia and schizophrenia-like psychosis evaluated by means of routine registration.
AbstractFor most patients suffering from schizophrenia or other chronic psychoses, uninterrupted contact with psychiatric services for a long period is necessary. By means of routine registrations in Copenhagen County, the use of services in 1995 for patients suffering from schizophrenia or other ICD-10 F2 diagnoses (n = 1356) was analysed. Substantial interregional differences were found in admission to more than one psychiatric department, admission to more than one similar ward, interruption in treatment and loss of contact with the patient. More than 25% had contact with at least four treatment modalities during 1995, and the proportion of patients who experienced interruption in treatment at least once during the year varied between 19% and 37%. It is concluded that routine registration of psychiatric services is a suitable means for quality assurance and ought to be used regularly in analyses like the one presented here. In concert with the literature, it is concluded that the interregional differences indicate that compliance with treatment can be improved by better organization of the psychiatric treatment.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
2Nervenarzt 2002 Nov 73: 1075-81
PMID12430050
Title[Psychotherapy in a psychiatric hospital].
AbstractThis study was aimed to evaluate the role of psychotherapy in psychiatric in-patient care at the example of the Bezirksklinikum Regensburg (BKR) (Community Clinic in Regensburg, Germany). Based on a sample of 6,719 patients suffering from F2-F6 ICD-10 diagnoses, the data of the psychiatric basic documentation (BADO) from January 1995 until April 1999 was retrospectively analysed regarding type and frequency of psychotherapy, influencing factors on indication, and effects of psychotherapy on treatment success. In 33% of cases, specific psychotherapy was in use. A client-centered therapy was carried out in 20% of patients. Other techniques of psychotherapy such as behaviour therapy, cognitive therapy, IPT for schizophrenics, or psychodynamic psychotherapy were applied to 2-6% of patients. Inpatients with eating disorders, personality disorders, neurotic disorders, somatization disorders, and depression were more likely to receive a specific psychotherapy. A significantly positive effect on treatment success was only documented in affective disorders, whereas a significantly negative influence was found in personality disorders.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
3Seishin Shinkeigaku Zasshi 2003 -1 105: 1254-64
PMID14679782
Title[Suicide among psychiatric patients in Fukuoka Prefecture].
AbstractTo investigate suicide among psychiatric patients in Japan (mainly Fukuoka prefecture), a questionnaire survey was submitted to psychiatrists from departments of psychiatry of university hospitals in Japan, departments of psychiatry of Rosai Hospitals in Japan, psychiatric hospitals in Fukuoka prefecture, psychiatric clinics in Fukuoka prefecture, and departments of psychiatry of general hospitals in Fukuoka prefecture regarding their psychiatric patients who died from suicide (266 females and 267 males). A large proportion of the patients at completed suicide was aged within the thirties to fifties. The majority of patients suffered from either F3 (mood disorders) or F2 (schizophrenia, schizotypal and delusional disorders) categories of the ICD-10 classification. Approximately one-fifth of the patients in Fukuoka prefecture had jobs at the time of completed suicide. The main "occupational risk factors" that were found to be risks for suicide were "failure or overloaded responsibilities in their jobs" and "worsening business situation". The main "other risk factors", i.e., risk factors other than "occupational risk factors" were "worsening psychiatric conditions", "personal life events (e.g., somatic illness or marital discord)" and "life events in other family members (e.g., familial discord or familial problems)". Over 50% of all cases had both "occupational risk factors" and "other risk factors", suggestive of the necessity for multidimensional evaluation and care in the treatment of suicidal patients. Given that numerous males that suffer from psychiatric disorders commit suicide without seeing a psychiatrist, it is important to establish a system to treat them appropriately in order to prevent unnecessary deaths.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
4Seishin Shinkeigaku Zasshi 2003 -1 105: 1254-64
PMID14679782
Title[Suicide among psychiatric patients in Fukuoka Prefecture].
AbstractTo investigate suicide among psychiatric patients in Japan (mainly Fukuoka prefecture), a questionnaire survey was submitted to psychiatrists from departments of psychiatry of university hospitals in Japan, departments of psychiatry of Rosai Hospitals in Japan, psychiatric hospitals in Fukuoka prefecture, psychiatric clinics in Fukuoka prefecture, and departments of psychiatry of general hospitals in Fukuoka prefecture regarding their psychiatric patients who died from suicide (266 females and 267 males). A large proportion of the patients at completed suicide was aged within the thirties to fifties. The majority of patients suffered from either F3 (mood disorders) or F2 (schizophrenia, schizotypal and delusional disorders) categories of the ICD-10 classification. Approximately one-fifth of the patients in Fukuoka prefecture had jobs at the time of completed suicide. The main "occupational risk factors" that were found to be risks for suicide were "failure or overloaded responsibilities in their jobs" and "worsening business situation". The main "other risk factors", i.e., risk factors other than "occupational risk factors" were "worsening psychiatric conditions", "personal life events (e.g., somatic illness or marital discord)" and "life events in other family members (e.g., familial discord or familial problems)". Over 50% of all cases had both "occupational risk factors" and "other risk factors", suggestive of the necessity for multidimensional evaluation and care in the treatment of suicidal patients. Given that numerous males that suffer from psychiatric disorders commit suicide without seeing a psychiatrist, it is important to establish a system to treat them appropriately in order to prevent unnecessary deaths.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
5BMC Med. Genet. 2004 Dec 5: 30
PMID15613245
TitleCatechol-O-methyltransferase (COMT) Val108/158 Met polymorphism does not modulate executive function in children with ADHD.
AbstractAn association has been observed between the catechol-O-methyltransferase (COMT) gene, the predominant means of catecholamine catabolism within the prefrontal cortex (PFC), and neuropsychological task performance in healthy and schizophrenic adults. Since several of the cognitive functions typically deficient in children with Attention Deficit Hyperactivity Disorder (ADHD) are mediated by prefrontal dopamine (DA) mechanisms, we investigated the relationship between a functional polymorphism of the COMT gene and neuropsychological task performance in these children.
The Val108/158 Met polymorphism of the COMT gene was genotyped in 118 children with ADHD (DSM-IV). The Wisconsin Card Sorting Test (WCST), Tower of London (TOL), and Self-Ordered Pointing Task (SOPT) were employed to evaluate executive functions. Neuropsychological task performance was compared across genotype groups using analysis of variance.
ADHD children with the Val/Val, Val/Met and Met/Met genotypes were similar with regard to demographic and clinical characteristics. No genotype effects were observed for WCST standardized perseverative error scores [F2,97 = 0.67; p > 0.05], TOL standardized scores [F2,99 = 0.97; p > 0.05], and SOPT error scores [F2,108 = 0.62; p > 0.05].
Contrary to the observed association between WCST performance and the Val108/158 Met polymorphism of the COMT gene in both healthy and schizophrenic adults, this polymorphism does not appear to modulate executive functions in children with ADHD.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
6Psychiatr Prax 2004 Jan 31: 28-33
PMID14727196
Title[Voluntariness and coercion in patients with schizophrenia].
AbstractAssociations between voluntariness of treatment, success of treatment, and number of hospital admissions should be examined.
88 consecutive admissions with ICD-10 F2 disorders were assessed using the PANSS and the GAF at admission and discharge. Voluntariness was assessed regarding admission, hospital stay, medication, time of discharge, and treatment continuation in four degrees for each category.
Voluntariness increased significantly with the number of hospital admissions in women. Outcome measures (PANSS and GAF differences admission/discharge and the respective differences divided by number of inpatient days) were not significantly related to any aspect of voluntariness. Voluntariness was negatively associated with PANSS-scores at admission, but not at discharge. Aggressive behaviour and coercive measures were observed more frequently in patients with aspects of involuntariness.
The short-term success of treatment in acute schizophrenic episodes seems not to be affected by measures of compulsive treatment. There is some evidence that experiences with former inpatient treatment increase the degree of voluntariness in women.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
7Psychiatr Prax 2004 Jan 31: 28-33
PMID14727196
Title[Voluntariness and coercion in patients with schizophrenia].
AbstractAssociations between voluntariness of treatment, success of treatment, and number of hospital admissions should be examined.
88 consecutive admissions with ICD-10 F2 disorders were assessed using the PANSS and the GAF at admission and discharge. Voluntariness was assessed regarding admission, hospital stay, medication, time of discharge, and treatment continuation in four degrees for each category.
Voluntariness increased significantly with the number of hospital admissions in women. Outcome measures (PANSS and GAF differences admission/discharge and the respective differences divided by number of inpatient days) were not significantly related to any aspect of voluntariness. Voluntariness was negatively associated with PANSS-scores at admission, but not at discharge. Aggressive behaviour and coercive measures were observed more frequently in patients with aspects of involuntariness.
The short-term success of treatment in acute schizophrenic episodes seems not to be affected by measures of compulsive treatment. There is some evidence that experiences with former inpatient treatment increase the degree of voluntariness in women.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
8Soc Psychiatry Psychiatr Epidemiol 2004 Sep 39: 686-94
PMID15672288
TitleOccupation, social support and quality of life in persons with schizophrenic or affective disorders.
AbstractMost people suffering from severe mental illness (SMI) lack paid employment. This study investigates the relationship between work status and objective as well as subjective quality of life (QoL) in people with SMI.
The sample consists of 261 subjects (102 women, 159 men) aged 35 (men) and 38 (women) years on average, of whom 158 suffer from a schizophrenic disorder (ICD-10: F2) and 103 were diagnosed as having an affective disorder (ICD-10: F3). Subjective QoL was assessed with the WHOQOL-BREF scale.
Subjects with an occupation in general have a larger social network at their disposal and receive more social support. With regard to income, few (12%) of the subjects with a job on the open labour market live below the poverty level, but many (28-38%) of those engaged in sheltered or other work-like activities do. Occupation ameliorates satisfaction with life domains referring to social integration (social relationships, environment), whereas the individual's well-being (psychological, physical) is hardly affected. Social support is an important mediator of the relationship between occupation and subjective QoL. Income is weakly and negatively related to subjective QoL.
Supportive relationships to colleagues at the workplace mainly explain the better subjective QoL of SMI people with an occupation. When designing specific employment possibilities for people with SMI, we should take notice of the social support dimension at the workplace. Mentally ill people have a substantial poverty risk, even when they are working. In particular, payment for sheltered work should be ameliorated.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
9Seishin Shinkeigaku Zasshi 2005 -1 107: 423-36
PMID15981618
Title[A clinical trial for developing PICU management scale, a tool reviewing the frequency and use of seclusion and restraint in psychiatric acute care].
AbstractMedical management in psychiatric acute care involving seclusion and restraint is an intervention of which reasonable use is often required. Regarding such measures, guidelines for seclusion and restraint are important, and also, psychiatric treatment facilities should engage in a continuous quality improvement process that seeks to minimize the use of seclusion and restraint. To review and monitor the existing use of seclusion and restraint, the authors developed a tool, the "PICU management scale", and investigated its usefulness in two functionally different psychiatric wards, a psychiatric emergency care unit (emergency ward) and a psychiatric acute care unit (acute ward) in the Japanese payment system. The PICU management scale is a tool which classifies the status of psychiatric intensive care into six categories by four factors; "S: seclusion", "R: restraint", "N: forced nutrition" and "Ph: physical care", and we evaluated its usefulness by occurrence of variance. In terms of minimizing or optimizing the use of seclusion and restraint, we also analyzed characteristics and risk factors of 1) recurrent application of seclusion and restraint, 2) high PICU management ranking, and 3) prolongation.
During the five months of investigation, medical management involving seclusion and restraint was applied in 98 cases at the emergency ward and 50 at the acute ward. The total number of management days was 894 and 950, respectively. The mean management duration per case was 9.1 and 19.0 days, respectively. The variance was 2.5 % and 4.5 %, respectively, and our tool covered most of the statuses and conditions observed in psychiatric emergency and acute care. Analysis of the variance suggested the existence of a trend which is considered to be typical of the status of medical management. Most cases that required recurrent application of seclusion and restraint were diagnosed as F0 or F2 in ICD -10, and hebephrenic cases with a high grade of disability, refractory-paranoid schizophrenic, or drug-resistant cases in F2 were remarkable in this category. In the high PICU management ranking, most cases were related to consciousness disturbance, and the mean duration of intervention was short. Reversal of the therapeutic stage was considered to be a risk factor of prolongation.
The "PICU management scale" is considered to be a useful tool for minimizing the use of seclusion and restraint, in addition to the guidelines for the use of seclusion and restraint. Contributions to team strategy and consensus by the addition of objectivity or symbolizing are also expected. To verify these findings and make further progress, more clinical trials using this tool in various institutions are required.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
10Seishin Shinkeigaku Zasshi 2006 -1 108: 694-704
PMID16999336
Title[Is the incidence of schizophrenia declining?: an investigation of the examination rates in the psychiatric clinics of a medical school hospital and a general hospital].
AbstractSome researchers in Europe, America and Oceania have recently reported that the incidence of schizophrenia is declining. We investigated changes in the proportion of schizophrenic patients to the total number of patients in two Japanese hospitals during the last decade.
The subjects were patients who first consulted the psychiatric clinic of Jichi Medical School or the psychiatric clinic of Kamitsuga General Hospital between December 1993 and November 1994 or between December 2003 and November 2004. Both clinics accepted new patients without prior appointments. Patients were classified using ICD-10 criteria (F0-F9, G40). The sex distribution of the patients and the mean age at first contact were compared for the two time periods. The proportion of schizophrenia (F2 in the ICD-10 criteria) to the total number of patients was compared for the two time periods after standardizing the populations with regard to age using the "1985 model population in Japan."
A decade ago, 398 patients first contacted the psychiatric clinic of the medical school hospital, compared with 958 patients in the recent investigation. A decade ago, 166 patients first contacted the psychiatric clinic of the general hospital, compared with 407 patients in the recent investigation. No differences in the sex ratios of the two groups were noted. The mean age of the patients visiting the medical school significantly increased by 3.5 years (36.9 to 40.4 years), while that of the patients visiting the general hospital significantly increased by 10.0 years (46.2 to 56.2 years). The proportion of schizophrenia patients in the medical hospital decreased from 8.5% to 6.9%, while that in the general hospital decreased from 11.0% to 5.4%. Only the change in the proportion of schizophrenia patients at the general hospital was significant.
The facts that the mean age of first-contact patients has risen and that the number of first-contact patients has increased approximately 2.5-fold suggests a change in the composition of first-contact patients in the last decade. We have some reservations regarding the comparison of these two groups. Although the actual number of first-contact patients with schizophrenia increased in both clinics, we found that the proportions of schizophrenia patients decreased in both clinics after standardizing the populations with regard to age. This finding must be investigated in view of other factors, including the overall age distribution of first-contact patients, increases in the proportions of affective disorders and organic mental disorders, and so on.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
11Seishin Shinkeigaku Zasshi 2006 -1 108: 694-704
PMID16999336
Title[Is the incidence of schizophrenia declining?: an investigation of the examination rates in the psychiatric clinics of a medical school hospital and a general hospital].
AbstractSome researchers in Europe, America and Oceania have recently reported that the incidence of schizophrenia is declining. We investigated changes in the proportion of schizophrenic patients to the total number of patients in two Japanese hospitals during the last decade.
The subjects were patients who first consulted the psychiatric clinic of Jichi Medical School or the psychiatric clinic of Kamitsuga General Hospital between December 1993 and November 1994 or between December 2003 and November 2004. Both clinics accepted new patients without prior appointments. Patients were classified using ICD-10 criteria (F0-F9, G40). The sex distribution of the patients and the mean age at first contact were compared for the two time periods. The proportion of schizophrenia (F2 in the ICD-10 criteria) to the total number of patients was compared for the two time periods after standardizing the populations with regard to age using the "1985 model population in Japan."
A decade ago, 398 patients first contacted the psychiatric clinic of the medical school hospital, compared with 958 patients in the recent investigation. A decade ago, 166 patients first contacted the psychiatric clinic of the general hospital, compared with 407 patients in the recent investigation. No differences in the sex ratios of the two groups were noted. The mean age of the patients visiting the medical school significantly increased by 3.5 years (36.9 to 40.4 years), while that of the patients visiting the general hospital significantly increased by 10.0 years (46.2 to 56.2 years). The proportion of schizophrenia patients in the medical hospital decreased from 8.5% to 6.9%, while that in the general hospital decreased from 11.0% to 5.4%. Only the change in the proportion of schizophrenia patients at the general hospital was significant.
The facts that the mean age of first-contact patients has risen and that the number of first-contact patients has increased approximately 2.5-fold suggests a change in the composition of first-contact patients in the last decade. We have some reservations regarding the comparison of these two groups. Although the actual number of first-contact patients with schizophrenia increased in both clinics, we found that the proportions of schizophrenia patients decreased in both clinics after standardizing the populations with regard to age. This finding must be investigated in view of other factors, including the overall age distribution of first-contact patients, increases in the proportions of affective disorders and organic mental disorders, and so on.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
12PLoS Biol. 2007 Nov 5: e297
PMID18001149
TitleFabp7 maps to a quantitative trait locus for a schizophrenia endophenotype.
AbstractDeficits in prepulse inhibition (PPI) are a biological marker for schizophrenia. To unravel the mechanisms that control PPI, we performed quantitative trait loci (QTL) analysis on 1,010 F2 mice derived by crossing C57BL/6 (B6) animals that show high PPI with C3H/He (C3) animals that show low PPI. We detected six major loci for PPI, six for the acoustic startle response, and four for latency to response peak, some of which were sex-dependent. A promising candidate on the Chromosome 10-QTL was Fabp7 (fatty acid binding protein 7, brain), a gene with functional links to the N-methyl-D-aspartic acid (NMDA) receptor and expression in astrocytes. Fabp7-deficient mice showed decreased PPI and a shortened startle response latency, typical of the QTL's proposed effects. A quantitative complementation test supported Fabp7 as a potential PPI-QTL gene, particularly in male mice. Disruption of Fabp7 attenuated neurogenesis in vivo. Human FABP7 showed altered expression in schizophrenic brains and genetic association with schizophrenia, which were both evident in males when samples were divided by sex. These results suggest that FABP7 plays a novel and crucial role, linking the NMDA, neurodevelopmental, and glial theories of schizophrenia pathology and the PPI endophenotype, with larger or overt effects in males. We also discuss the results from the perspective of fetal programming.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
13PLoS Biol. 2007 Nov 5: e297
PMID18001149
TitleFabp7 maps to a quantitative trait locus for a schizophrenia endophenotype.
AbstractDeficits in prepulse inhibition (PPI) are a biological marker for schizophrenia. To unravel the mechanisms that control PPI, we performed quantitative trait loci (QTL) analysis on 1,010 F2 mice derived by crossing C57BL/6 (B6) animals that show high PPI with C3H/He (C3) animals that show low PPI. We detected six major loci for PPI, six for the acoustic startle response, and four for latency to response peak, some of which were sex-dependent. A promising candidate on the Chromosome 10-QTL was Fabp7 (fatty acid binding protein 7, brain), a gene with functional links to the N-methyl-D-aspartic acid (NMDA) receptor and expression in astrocytes. Fabp7-deficient mice showed decreased PPI and a shortened startle response latency, typical of the QTL's proposed effects. A quantitative complementation test supported Fabp7 as a potential PPI-QTL gene, particularly in male mice. Disruption of Fabp7 attenuated neurogenesis in vivo. Human FABP7 showed altered expression in schizophrenic brains and genetic association with schizophrenia, which were both evident in males when samples were divided by sex. These results suggest that FABP7 plays a novel and crucial role, linking the NMDA, neurodevelopmental, and glial theories of schizophrenia pathology and the PPI endophenotype, with larger or overt effects in males. We also discuss the results from the perspective of fetal programming.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
14Psychol Rep 2007 Aug 101: 171-6
PMID17958125
TitleComparison of separation patterns between parents and offspring in psychiatric and nonclinical families.
AbstractThis study examined the specific separation patterns of binding and expelling in families with young adults. 103 families were divided into three groups according to the ICD-10 diagnosis of offspring (18-35 years old): (1) schizophrenia (ns=32 mothers and 30 fathers), (2) personality disorders (ns=34 mothers and 30 fathers), (3) control, nonclinical group (ns=34 mothers and 32 fathers). The participants (mothers and fathers) independently completed the Relational Individuation Questionnaire designed for this study. Despite expectations, there was no statistical significance found between the mean scores of the parents' binding of offspring diagnosed with schizophrenia or personality disorders or from the nonclinical families. There was, however, a difference in the intensity of the mothers' expelling (F2.97 = 10.90, p < .0001) and of the fathers' expelling (F2.89 = 5.96, p < .005) from different family groups. The parents of offspring from clinical families expelled their offspring more intensively than parents from nonclinical families. The correlation between expelling by mothers and expelling by fathers in all families was positive. These results suggest that expelling may be a strategy used by parents with children with serious mental disorders when these children reach young adulthood.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
15Eur. Psychiatry 2007 Apr 22: 160-6
PMID17227704
TitleSocial disability in different mental disorders.
AbstractTo assess the social disability of people with different psychiatric disorders.
Cross-site survey in five psychiatric hospitals (Dresden, Wroc?aw, London, Michalovce and Prague). Working-aged patients diagnosed (ICD-10) with schizophrenia and related disorders (F2), affective disorders (F3), anxiety disorders (F4), eating disorders (F5) and personality disorders (F6), were assessed at admission (n=969) and 3 months after discharge (n=753) using the Brief Psychiatric Rating Scale and the Groningen Social Disability Schedule. The main outcome measure was Interviewer-rated social disability.
During acute episodes patients with personality, eating and schizophrenic disorders functioned less effectively than those with affective or anxiety disorders. After controlling for age and severity of psychopathology, there was no significant effect of the diagnosis (during remission), sex, education and history of disorder on disability. Site, employment and partnership were significant factors for the level of social disability in both measure points.
Severity of psychopathological symptoms, not the diagnosis of a mental disorder, was the most significant factor in determining the level of social functioning, particularly during the remission period. Site, employment and partnership appeared as significant factors influencing the level of social disability.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
16Eur. Psychiatry 2007 Apr 22: 160-6
PMID17227704
TitleSocial disability in different mental disorders.
AbstractTo assess the social disability of people with different psychiatric disorders.
Cross-site survey in five psychiatric hospitals (Dresden, Wroc?aw, London, Michalovce and Prague). Working-aged patients diagnosed (ICD-10) with schizophrenia and related disorders (F2), affective disorders (F3), anxiety disorders (F4), eating disorders (F5) and personality disorders (F6), were assessed at admission (n=969) and 3 months after discharge (n=753) using the Brief Psychiatric Rating Scale and the Groningen Social Disability Schedule. The main outcome measure was Interviewer-rated social disability.
During acute episodes patients with personality, eating and schizophrenic disorders functioned less effectively than those with affective or anxiety disorders. After controlling for age and severity of psychopathology, there was no significant effect of the diagnosis (during remission), sex, education and history of disorder on disability. Site, employment and partnership were significant factors for the level of social disability in both measure points.
Severity of psychopathological symptoms, not the diagnosis of a mental disorder, was the most significant factor in determining the level of social functioning, particularly during the remission period. Site, employment and partnership appeared as significant factors influencing the level of social disability.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
17Eur Arch Psychiatry Clin Neurosci 2007 Feb 257: 47-53
PMID17033915
TitlePsychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders.
AbstractThe aim was to investigate the hypothesis that patients with first episode schizophrenic disorders have a more favorable treatment response than those with multiple episodes.
A total of 400 inpatients from an ongoing multi-centre, follow-up program who fulfilled ICD-10 criteria for schizophrenic disorders (F2) were assessed at admission to and discharge from hospital using the Positive and Negative Syndrome Scale (PANSS).
At admission, first episode patients (n = 121) showed higher levels of positive symptoms (PANSS positive subscore) and lower ones of negative symptoms (PANSS negative subscore) than multiple episode patients (n = 279), whereas the global disease severity (PANSS total score) was comparable. Analyses of covariance revealed that treatment response (adjusted symptom levels at discharge) was more favorable in first-episode patients, with respect to both positive and negative symptoms.
The results are compatible with the hypothesis that treatment response becomes less favorable during the course of schizophrenic illness. This finding might be associated with progressive neurobiological alterations.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
18Clin Pract Epidemiol Ment Health 2007 -1 3: 30
PMID18053203
TitleFrequency and severity of aggressive incidents in acute psychiatric wards in Switzerland.
AbstractAggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult.
To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland.
We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R) and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days.
A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10-1.78) for physical attacks and 1.83 (1.70-1.97) for all aggressive incidents (including purely verbal aggression). The mean severity was 8.80 +/- 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (>/= 9 pts.). 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6-2.9), longer length of stay (OR 2.7; 2.0-3.8), and a diagnosis of schizophrenia (ICH-10 F2) (OR 2.1; 1.5-2.9) was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission.
Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the study design we consider the incidence rates as robust and representative for acute wards in German speaking Switzerland, and thus useful as reference for comparative and interventional research. Implications for clinical practice include the recommendation to extend the systematic risk assessment beyond the first days after admission. The study confirms the necessity to differentiate between types of aggressive behaviour when reporting and comparing incidence-data.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
19Psychiatry Clin. Neurosci. 2007 Oct 61: 495-501
PMID17875027
TitleSymptom dimensions and needs of care among patients with schizophrenia in hospital and the community.
AbstractThe purpose of the present paper was to examine the psychiatric symptom dimensions related to needs of care among patients with schizophrenia in hospital and in the community. Subjects were 217 patients with F2 ICD-10 diagnoses. Hospital patients included 102 inpatients (47.0%) in psychiatric long-term care units. Community patients included 115 outpatients (53.0%) living in their homes or residential facilities. Psychiatrists used the Brief Psychiatric Rating Scale (BPRS) to assess patients' psychiatric symptoms. Formal care providers assessed needs of care using a scale developed by the Committee on Case Management Guidelines for People with Mental Disabilities in Japan. Instrumental Activities of Daily Living (IADL) self-performance and difficulty were also measured using a scale from the Minimum Data Set-Home Care (MDS-HC). Multiple regression analyses were applied, using the symptom dimensions as dependent variables and needs of care as independent variables. Patient group (hospital or community) was also used as an independent variable. Hospital patients demonstrated more severe psychiatric symptoms and greater needs of care than community patients. Multiple regression analyses showed that the total needs of care were greater among male patients (B = 0.142, P = 0.005), hospital patients (B = 0.310, P < 0.001), patients with poor IADL self-performance (B = 0.217, P = 0.047), and patients with severe negative symptoms (B = 0.240, P = 0.002; R(2) = 0.515). The present results suggested an association between negative symptoms and needs of care in schizophrenia. Hospital patients had greater needs of care, even though their psychiatric symptoms were controlled for. Further research should examine the relationships between psychiatric symptoms and needs of care in a cohort study following patients when hospitalized and when living in the community.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
20Clin Pract Epidemiol Ment Health 2007 -1 3: 1
PMID17274830
TitleThe use of mechanical restraint and seclusion in patients with schizophrenia: a comparison of the practice in Germany and Switzerland.
AbstractThe use of coercive measures is an indicator of the quality of psychiatric inpatient treatment. To date, there is no data available to European comparisons on the incidence of such measures.
The frequency and duration of mechanical restraint and seclusion on patients with a diagnosis of F2 ICD-10 was analysed in seven German and seven Swiss psychiatric hospitals in the year 2004 using three indicators. Differences between German and Swiss hospitals regarding the indicators were tested for statistical significance using Mann-Whitney-U-tests.
6.6 % (Switzerland) and 10.4 % (Germany) of admissions respectively were affected by mechanical restraint and 17.8 % (Switzerland) and 7.8 % (Germany) respectively by seclusion. Seclusion as well as mechanical restraint per case were applied significantly more often in German than in Swiss hospitals and were of significantly longer duration in Swiss than in German hospitals.
The results showed different patterns in the use of seclusion and mechanical restraint across Swiss and German hospitals. For future European research on the use of compulsory measures in routine psychiatric care, there is a need for uniformed definitions, reliable documentation of coercive measures as well as for an identical way of data analysis. To meet these conditions is the first step to achieve European standards for the use of coercive measures.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
21Nervenarzt 2007 Jul 78: 809-17
PMID17106727
Title[The effects of stalking on psychiatrists, psychotherapists and psychologists. Prevalence of stalking and its emotional impact].
AbstractStalking in the psychiatric context describes a pathological behaviour which is characterized by repeated persecution, harassment, or menacing of or assault on a person. Because of the association between stalking and mental disorders, psychiatrists, psychologists and psychotherapists belong to particularly exposed professions. If they fall victim to stalking during their career, disruptive impacts up to posttraumatic stress disorder (PTSD) can be the consequence. A total of 117 psychiatrists, psychologists or psychotherapists in Graz participated in an anonymous interview. To register possible experiences with stalking defined behaviour, a modified version of the questionnaire of Kamleiter was used. The prevalence and severity of posttraumatic stress symptoms were determined using the Impact of Event Scale of Horowitz. The study showed an incidence of stalking of 38.5%. The rate of female stalkers (60%) was extraordinary high. Most victims (68.9%) experienced non-violent threats. Most of the offenders (41.9%) were diagnosed as suffering from schizophrenia, schizotype and delusional disorders (F2) followed by disorders of adult personality and behaviour (F6) (30.2%). Some 44.4% of the victims developed symptoms of PTSD, which were usually only slight. The analyses suggest that stalking, in the psychiatric field of activity, is a common and serious phenomenon, and that strategies for the prevention and protection of potentially affected professions have to be developed.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
22Int J Geriatr Psychiatry 2007 May 22: 401-4
PMID17096460
TitleQuetiapine indication shift in the elderly: diagnosis and dosage in 208 psychogeriatric patients from 2000 to 2006.
AbstractQuetiapine was approved in Germany as an atypical antipsychotic for treatment of schizophrenia in 2000, followed by the approval as an antipsychotic for treatment of bipolar mania in 2003. The approval of quetiapine for treatment of bipolar depression is expected. We hypothesized that the psychogeriatric prescription pattern for quetiapine shifts from the psychotic to the affective spectrum.
Retrospectively we screened discharge reports of all geriatric inpatients of the psychiatric department of the Ruhr-University of Bochum in the period from January 2001 until March 2006 and identified 208 individual patients aged over 60 years, who had received quetiapine as final medication. Age, gender, daily drug dose, year of treatment and diagnosis (according to ICD-10) were recorded and analyzed.
Over the six-year time span, the proportion of affective disorders (F3) as indication for quetiapine in the elderly increased, whereas the proportion of dementia (F0) as indication for quetiapine decreased significantly. The proportion of schizophrenic disorders (F2) treated with quetiapine did not change significantly.
Since the decision of the German Federal Court in 2002 'off label' use goes to the expenses of the prescriber. So the decrease of quetiapine in dementia is probably due to its 'off label' status in dementia. The psychogeriatric indication shift for quetiapine towards affective disorders could be the consequence of good clinical experiences with the drug and growing evidence for its antidepressant effect.
In addition to controlled pharmacological trials prospective clinical research is needed to evaluate the prescription attitudes of clinicians.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
23Int J Geriatr Psychiatry 2007 May 22: 401-4
PMID17096460
TitleQuetiapine indication shift in the elderly: diagnosis and dosage in 208 psychogeriatric patients from 2000 to 2006.
AbstractQuetiapine was approved in Germany as an atypical antipsychotic for treatment of schizophrenia in 2000, followed by the approval as an antipsychotic for treatment of bipolar mania in 2003. The approval of quetiapine for treatment of bipolar depression is expected. We hypothesized that the psychogeriatric prescription pattern for quetiapine shifts from the psychotic to the affective spectrum.
Retrospectively we screened discharge reports of all geriatric inpatients of the psychiatric department of the Ruhr-University of Bochum in the period from January 2001 until March 2006 and identified 208 individual patients aged over 60 years, who had received quetiapine as final medication. Age, gender, daily drug dose, year of treatment and diagnosis (according to ICD-10) were recorded and analyzed.
Over the six-year time span, the proportion of affective disorders (F3) as indication for quetiapine in the elderly increased, whereas the proportion of dementia (F0) as indication for quetiapine decreased significantly. The proportion of schizophrenic disorders (F2) treated with quetiapine did not change significantly.
Since the decision of the German Federal Court in 2002 'off label' use goes to the expenses of the prescriber. So the decrease of quetiapine in dementia is probably due to its 'off label' status in dementia. The psychogeriatric indication shift for quetiapine towards affective disorders could be the consequence of good clinical experiences with the drug and growing evidence for its antidepressant effect.
In addition to controlled pharmacological trials prospective clinical research is needed to evaluate the prescription attitudes of clinicians.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
24Psychopathology 2007 -1 40: 47-53
PMID17065837
TitleThe relationship of reactive psychosis and ICD-10 acute and transient psychotic disorders: evidence from a case register-based comparison.
AbstractICD-10 introduced a new diagnostic category, F23 'acute and transient psychotic disorders' (ATPD), to embrace clinical concepts such as bouffée délirante, cycloid psychosis, psychogenic (reactive) psychosis and schizophreniform psychosis. The purpose of this study was to examine the relationship between the concept of reactive psychosis (RP), equivalent to the ICD-8 298 category of 'other psychoses', and ATPD.
Since January 1, 1994, ICD-10 has replaced ICD-8 as official classification in Denmark. Patients given an ICD-8 298 diagnosis on their last admission in 1992-1993 were identified from the Danish Psychiatric Central Register, and the ICD-8 diagnoses assigned were compared with their ICD-10 diagnoses when readmitted in 1994-1995.
Diagnosis of RP was recorded in 19.2% of patients with functional psychoses in 1992-1993, whereas ATPD overall prevalence accounted for 8.7% of those with non-organic psychotic and affective disorders in 1994-1995. Thirty-eight per cent of patients with an ICD-8 298 diagnosis were readmitted during the years 1994-1995. schizophrenia and related disorders (F2) and affective disorders (F3) accounted for three quarters of ICD-10 diagnoses. The most frequently used ATPD subcategories were F23.3 'other acute delusional psychotic disorders', F23.0 'acute polymorphic psychotic disorder without symptoms of schizophrenia' and F23.9 'acute and transient psychotic disorder unspecified'. A significant majority were female and associated acute stress was recorded only in 5.3% of cases.
ICD-8 298 register diagnosis of RP showed little empirical continuity to ATPD and conformed more to F23.3 acute delusional disorder among ATPD subtypes.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
25Biol. Psychiatry 2007 Mar 61: 688-93
PMID16920078
TitleToxoplasma gondii as a risk factor for early-onset schizophrenia: analysis of filter paper blood samples obtained at birth.
AbstractInfections during fetal life or neonatal period, including infections with Toxoplasma gondii, may be associated with a risk for schizophrenia and other mental disorders. The objectives of this study were to study the association between serological markers for maternal and neonatal infection and the risk for schizophrenia, related psychoses, and affective disorders in a national cohort of newborns.
This study was a cohort-based, case-control study combining data from national population registers and patient registers and a national neonatal screening biobank in Denmark. Patients included persons born in Denmark in 1981 or later followed up through 1999 with respect to inpatient or outpatient treatment for schizophrenia or related disorders (ICD-10 F2) or affective disorders (ICD-10 F3).
Toxoplasma gondii immunoglobulin G (IgG) levels corresponding to the upper quartile among control subjects were significantly associated with schizophrenia risk (odds ratio [OR] = 1.79, p = .045) after adjustment for urbanicity of place of birth, year of birth, gender, and psychiatric diagnoses among first-degree relatives. There was no significant association between any marker of infection and other schizophrenia-like disorders or affective disorders.
Our study supports an association between Toxoplasma gondii and early-onset schizophrenia. Further studies are needed to establish if the association is causal and if it generalizes to cases with onset after age 18.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
26Eur. Psychiatry 2007 Apr 22: 177-87
PMID17142014
TitleValidity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders.
AbstractThe EQ-5D is a generic questionnaire generating a health profile and a single index score for health-related quality of life. This study aimed to analyse the discriminative ability and validity of the EQ-5D in patients with schizophrenic, schizotypal or delusional disorders.
One hundred sixty-six patients with schizophrenic, schizotypal or delusional disorders (ICD-10 F2) completed the EQ-5D. Measures of quality of life (WHOQOL-BREF), utility (TTO), subjective (SCL-90R) and objective (PANSS, CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of EQ-5D scores. Validity of the EQ-5D self-classifier was analysed by assessing differences in related other scores grouped by response levels of EQ-5D items. Validity of the visual analogue scale (EQ VAS) and the EQ-5D index (UK social tariff) was analysed by assessing their correlation with all other scores.
Seventy-nine percent of respondents reported problems in at least one of the EQ-5D dimensions (anxiety/depression 57%, usual activities 45%, pain/discomfort 44%, self-care 29%, mobility 22%). The mean EQ VAS score/EQ-5D index was 65.7/0.71. The four most frequently reported EQ-5D health states covered 45% of all respondents. For almost all EQ-5D dimensions, different response levels were associated with significantly different scores of measures used for comparison. Correlation of EQ VAS score and EQ-5D index were largest with scores of subjective measures (SCL-90R: -0.50 and -0.73; WHOQOL mental subscore 0.62 and 0.58; always P<0.001).
The EQ-5D showed a moderate ceiling effect and seems to be reasonably valid in this patient group.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
27Eur. Psychiatry 2007 Apr 22: 177-87
PMID17142014
TitleValidity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders.
AbstractThe EQ-5D is a generic questionnaire generating a health profile and a single index score for health-related quality of life. This study aimed to analyse the discriminative ability and validity of the EQ-5D in patients with schizophrenic, schizotypal or delusional disorders.
One hundred sixty-six patients with schizophrenic, schizotypal or delusional disorders (ICD-10 F2) completed the EQ-5D. Measures of quality of life (WHOQOL-BREF), utility (TTO), subjective (SCL-90R) and objective (PANSS, CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of EQ-5D scores. Validity of the EQ-5D self-classifier was analysed by assessing differences in related other scores grouped by response levels of EQ-5D items. Validity of the visual analogue scale (EQ VAS) and the EQ-5D index (UK social tariff) was analysed by assessing their correlation with all other scores.
Seventy-nine percent of respondents reported problems in at least one of the EQ-5D dimensions (anxiety/depression 57%, usual activities 45%, pain/discomfort 44%, self-care 29%, mobility 22%). The mean EQ VAS score/EQ-5D index was 65.7/0.71. The four most frequently reported EQ-5D health states covered 45% of all respondents. For almost all EQ-5D dimensions, different response levels were associated with significantly different scores of measures used for comparison. Correlation of EQ VAS score and EQ-5D index were largest with scores of subjective measures (SCL-90R: -0.50 and -0.73; WHOQOL mental subscore 0.62 and 0.58; always P<0.001).
The EQ-5D showed a moderate ceiling effect and seems to be reasonably valid in this patient group.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
28Psychiatr Prax 2008 Sep 35: 279-85
PMID18773374
Title[The regional psychiatry budget: costs and effects of a new multisector financing model for psychiatric care].
AbstractTo evaluate a new multi-sector financing model for psychiatric care based on the capitation principle (Regional Psychiatry Budget, RPB).
Patients with a diagnosis according to ICD-10 F10, F2, and F3 were interviewed in the model region (MR, N=258) and a control region (CR, N=244) financed according to the fee-for-service principle. Effectiveness of care was assessed before RPB-introduction and after 1.5 years. Use of care was determined semi-annually.
Costs of inpatient psychiatric treatment decreased more strongly in the MR, while hospital based outpatient care and day clinic treatment were intensified in comparison to the CR. Quality of life, severity of illness and illness-specific symptoms in patients improved similarly in MR and CR. The functional level improved more in the MR than in the CR, which was especially evident in schizophrenia patients.
Inpatient psychiatric care costs can be reduced with the RPB without compromising the quality of care.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
29Nord J Psychiatry 2008 -1 62: 77-81
PMID18389429
TitleCoercion in patients who at their first contact with the psychiatric services system were diagnosed within the schizophrenia-spectrum in Denmark. A register study.
AbstractThe level of use of coercive measures in patients diagnosed with a schizophrenia-spectrum disorder at their first contact with the psychiatric services system in Denmark is not known. The aim of the study was to investigate the level of use of coercive measures during first year of contact in this group of patients. Using the longitudinal national registers, the use of coercive measures for each individual was calculated in a 1-year period from 1 January 1999 to 31 December 2001, for patients in Denmark who at their first contact with the psychiatric services system were diagnosed within the schizophrenia-spectrum (F2 in ICD 10); 2222 patients were identified. The mean age was 30.7 years and 63.6% were males; 554 patients (24.9%) experienced use of coercive measures. A total of 222 patients (10.0%) were admitted involuntarily, 308 (13.9%) were detained. Seventy-two patients (3.2%) were treated involuntarily with anti-psychotic medication and 158 (7.1%) with sedative medication. A total of 241 patients (10.8%) were restrained with a leather belt, and 84 patients (3.8%) with a leather belt and strap(s). The mean duration of involuntary admission was 30.3 days. The mean duration of restraint with a leather belt was 2.66 days. This study provides information about the level of use of coercive measures in first-episode schizophrenia-spectrum disorders in Denmark.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
30Eur Arch Psychiatry Clin Neurosci 2009 Dec 259: 433-43
PMID19381705
TitleAcute and transient psychotic disorders (ICD-10 F23): a review from a European perspective.
AbstractThe tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10) introduced the category F23 'Acute and transient psychotic disorders' (ATPD) to incorporate clinical concepts such as the French bouffée délirante, cycloid psychosis (Germany), and the Scandinavian reactive and schizophreniform psychoses. The aim of this paper is to review the literature on ATPD and to examine how it has been differentiated from the other categories of F2 group 'schizophrenia and related disorders'. Papers published between 1993 and 2007 were found through searches in Medline, PsychInfo and Google Scholar. Further references were identified from book chapters and comprehensive reviews of the topic. ATPD is reported as being prevalent in females and as having onset in early-middle adulthood. Although follow-up studies suggest that its outcome is more favourable than other disorders in the F2 group, ATPD tends to recur and half of cases convert mainly into either schizophrenia or affective disorders. No evidence supports the view that the traditional conditions subsumed under ATPD all refer to this diagnostic category. The lack of defining features and poor prognostic validity argue against the separation of ATPD from borderland categories.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
31Rehabilitation (Stuttg) 2009 Oct 48: 270-6
PMID19847722
Title[Can quality of life in psychotherapy be measured with clinician-ratings? A comparison of patient- and clinician-ratings using the SF-8].
AbstractQuality of life is a major criterion of the outcome of psychotherapeutic interventions. The concept of quality of life emphasizes patient self-ratings. However, they can be burdensome or inappropriate in some cases. Therefore we have compared self-ratings and clinician-ratings of quality of life.
Self- and clinician-ratings of the SF-8 (1-week recall version) were measured from consecutive samples of 1 812 inpatients from eleven psychotherapeutic clinics at admission and at discharge six weeks later. A physical summary score (PSS) and a mental summary score (MSS) were calculated. Pearson product-moment correlations were used.
Self- and clinician-ratings of the PSS correlate r=0.48 at admission and r=0.58 at discharge, of the MSS r=0.46 and r=0.51, respectively. Concerning single items we find the highest correlation for item 4 (bodily pain: r=0.53 and r=0.55), the lowest for item 6 (social functioning: r=0.26 and r=0.30). Change scores of the PSS correlate r=0.20, of the MSS r=0.32. Correlations differ between diagnostic groups: Correlations are low for patients with either schizophrenia (F2), depressive episode (F32) or personality disorder (F60-62), comparatively higher for patients with dysthymia. Comparing correlations across the 11 clinics reveals substantial differences, for the MSS ranging from r=0.38 to r=0.58 at admission and r=0.27 to r=0.68 at discharge.
Patient self-ratings of quality of life as a psychotherapeutic outcome measure using the SF-8 Health Survey could not be substituted by clinician-ratings, they should be used as complements.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
32Psychiatry Clin. Neurosci. 2009 Oct 63: 658-62
PMID19674381
TitlePrevalence of i.v. thiopental use in psychiatric emergency settings in Japan.
AbstractBecause i.v. barbiturates such as thiopental carry the risk of apnea and laryngeal spasm in asthmatic patients, reducing the use of barbiturate in emergency situations is important. The purpose of the present study was therefore to investigate the prevalence of i.v. thiopental as a choice of sedation in behavioral emergency settings, we conducted a cross-sectional multicenter study.
Psychiatric emergency departments of seven hospitals were studied during a 4-month period. Patients with a score >15 on the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) who received i.v. medication were included in the study. Drugs were chosen according to the Japanese guidelines, in which the first injection was either haloperidol or benzodiazepine in accordance with clinical requirements. A second injection, which was the opposite drug to the first injection was administered as needed. Only when excitement obviously increased following the first injection, which was considered uncontrollable without thiopental according to expert experience, was thiopental given as a second injection. A total of 137 patients were included. The mean age was 40.4 years (SD 13.1), and the rate of male gender, drug-naïve, and F2 (schizophrenia, schizotypal and delusional disorders) on the ICD-10 were 48.9%, 29.9%, and 65.7%, respectively.
The rate of patients treated with thiopental as a second injection was 8.0% (n = 11). All of the first injections in patients treated with thiopental were not haloperidol but benzodiazepines (P = 0.0072).
Because this multicenter study has an epidemiological character, the prevalence of i.v. thiopental use in psychiatric emergency settings in Japan is considered to be 8.0%.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
33World J. Biol. Psychiatry 2009 -1 10: 27-33
PMID19673085
TitleIsoprostenes as indicators of oxidative stress in schizophrenia.
AbstractFree radicals induce oxidative stress and damage to all types of biological molecules and may be involved in pathology of schizophrenia. A cell membrane dysfunction caused by lipid peroxidation can be secondary to a free radical-mediated pathology and may contribute to specific aspects of schizophrenic symptomatology and complications of its treatment.
The aim of our study was to estimate oxidative stress in a group of schizophrenic patients by using different biomarkers of free radicals-induced lipid peroxidation (isoprostanes, thiobarbituric acid reactive substances (TBARS)). We also determined the products of enzymatic peroxidation of arachidonic acid, such as thromboxane B2 (TXB2) and its metabolite 11-dehydrothromboxane B2. Isoprostanes (IPs) are a family of novel prostaglandin isomers and are produced in free radical-catalysed reactions from arachidonic acid. They are useful as a specific, sensitive, chemically stable, noninvasive index of free radical generation in vivo. We therefore assessed in schizophrenic patients and control subjects the level of urinary excretion of isoprostane--8-epi-prostaglandin F2 alpha, (8-isoPGF2 alpha)--a marker of lipid peroxidation induced by free radicals using an immunoassay kit. We also studied the level of the other marker of enzymatic arachidonic acid peroxidation--11-dehydrothromboxane B2--in urine from schizophrenic patients and healthy volunteers. Moreover, we estimated the production of TBARS and TXB2 in plasma from schizophrenic patients and the control group. Patients hospitalised in the II Psychiatric Department of Medical University in Lodz, Poland, were interviewed with a special questionnaire (treatment, course of diseases, dyskinesis and other EPS). According to DSM-IV criteria, all patients had diagnosis of paranoid type. All patients were treated with second-generation antipsychotic drugs (risperidone, clozapine, and olanzapine). Mean time of schizophrenia duration was about 2 years.
We observed a statistically increased level of TBARS in plasma (P=0.000162) and isoprostanes (P=3.5 x 10(-12)) in urine of schizophrenic patients in comparison with the control group. The level of markers of enzymatic oxidation of arachidonic acid (TXB2 and its metabolite, 11-dehydrothromboxane B2) did not change. This indicates that free radicals induce peroxidation of unsaturated fatty acid in schizophrenic patients.
Considering the data presented in this study, we suggest that non-invasive measurement of 8-isoPGF2 alpha, is a valuable and sensitive (contrary to TBARS) indicator of oxidative stress status in vivo in schizophrenia.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
34World J. Biol. Psychiatry 2009 -1 10: 27-33
PMID19673085
TitleIsoprostenes as indicators of oxidative stress in schizophrenia.
AbstractFree radicals induce oxidative stress and damage to all types of biological molecules and may be involved in pathology of schizophrenia. A cell membrane dysfunction caused by lipid peroxidation can be secondary to a free radical-mediated pathology and may contribute to specific aspects of schizophrenic symptomatology and complications of its treatment.
The aim of our study was to estimate oxidative stress in a group of schizophrenic patients by using different biomarkers of free radicals-induced lipid peroxidation (isoprostanes, thiobarbituric acid reactive substances (TBARS)). We also determined the products of enzymatic peroxidation of arachidonic acid, such as thromboxane B2 (TXB2) and its metabolite 11-dehydrothromboxane B2. Isoprostanes (IPs) are a family of novel prostaglandin isomers and are produced in free radical-catalysed reactions from arachidonic acid. They are useful as a specific, sensitive, chemically stable, noninvasive index of free radical generation in vivo. We therefore assessed in schizophrenic patients and control subjects the level of urinary excretion of isoprostane--8-epi-prostaglandin F2 alpha, (8-isoPGF2 alpha)--a marker of lipid peroxidation induced by free radicals using an immunoassay kit. We also studied the level of the other marker of enzymatic arachidonic acid peroxidation--11-dehydrothromboxane B2--in urine from schizophrenic patients and healthy volunteers. Moreover, we estimated the production of TBARS and TXB2 in plasma from schizophrenic patients and the control group. Patients hospitalised in the II Psychiatric Department of Medical University in Lodz, Poland, were interviewed with a special questionnaire (treatment, course of diseases, dyskinesis and other EPS). According to DSM-IV criteria, all patients had diagnosis of paranoid type. All patients were treated with second-generation antipsychotic drugs (risperidone, clozapine, and olanzapine). Mean time of schizophrenia duration was about 2 years.
We observed a statistically increased level of TBARS in plasma (P=0.000162) and isoprostanes (P=3.5 x 10(-12)) in urine of schizophrenic patients in comparison with the control group. The level of markers of enzymatic oxidation of arachidonic acid (TXB2 and its metabolite, 11-dehydrothromboxane B2) did not change. This indicates that free radicals induce peroxidation of unsaturated fatty acid in schizophrenic patients.
Considering the data presented in this study, we suggest that non-invasive measurement of 8-isoPGF2 alpha, is a valuable and sensitive (contrary to TBARS) indicator of oxidative stress status in vivo in schizophrenia.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
35Psychiatry Clin. Neurosci. 2009 Oct 63: 658-62
PMID19674381
TitlePrevalence of i.v. thiopental use in psychiatric emergency settings in Japan.
AbstractBecause i.v. barbiturates such as thiopental carry the risk of apnea and laryngeal spasm in asthmatic patients, reducing the use of barbiturate in emergency situations is important. The purpose of the present study was therefore to investigate the prevalence of i.v. thiopental as a choice of sedation in behavioral emergency settings, we conducted a cross-sectional multicenter study.
Psychiatric emergency departments of seven hospitals were studied during a 4-month period. Patients with a score >15 on the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) who received i.v. medication were included in the study. Drugs were chosen according to the Japanese guidelines, in which the first injection was either haloperidol or benzodiazepine in accordance with clinical requirements. A second injection, which was the opposite drug to the first injection was administered as needed. Only when excitement obviously increased following the first injection, which was considered uncontrollable without thiopental according to expert experience, was thiopental given as a second injection. A total of 137 patients were included. The mean age was 40.4 years (SD 13.1), and the rate of male gender, drug-naïve, and F2 (schizophrenia, schizotypal and delusional disorders) on the ICD-10 were 48.9%, 29.9%, and 65.7%, respectively.
The rate of patients treated with thiopental as a second injection was 8.0% (n = 11). All of the first injections in patients treated with thiopental were not haloperidol but benzodiazepines (P = 0.0072).
Because this multicenter study has an epidemiological character, the prevalence of i.v. thiopental use in psychiatric emergency settings in Japan is considered to be 8.0%.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
36Comput Methods Programs Biomed 2010 Dec 100: 222-36
PMID20462652
TitleStatistical modeling of psychosis data.
AbstractPsychosis is a special type of mental disorder that affects around 2-3% of global population and has a strong genetic basis. Under psychosis, there is a group of diseases, which apparently may look alike and thus, it is difficult to isolate them from each other. Moreover, the credibility of real data related to psychosis is not only questionable due to its secondary nature but also its availability is grossly restricted because of the ethical constraints and prevailing social taboo. The present paper is a novel attempt to capture psychosis data by considering 24 input symptom constructs and 7 tentative responses (outputs) as per Brief Psychiatric Rating Scale-F2 (BPRS-F2). The captured input-output data as per Plackett-Burman design (PBD) of experiments (after consulting 40 psychiatrists) are statistically modeled, to determine their mutual relationships (i.e., outputs as the functions of inputs). Both Pareto-charts as well as normal probability plots are prepared to investigate the effect of each factor on different responses. Significant symptom construct(s) has/have been identified for each response. For example, emotional withdrawal has significant contribution towards schizophrenia, and so on. The psychosis data, thus collected, will be useful for further processing to extract more information of the said disease.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
37J. Evol. Biol. 2010 Apr 23: 678-86
PMID20149023
TitleTransgenerational memory effect of ageing in Drosophila.
AbstractChildren born to older parents tend to have lower intelligence and are at higher risk for disorders such as schizophrenia and autism. Such observations of ageing damage being passed on from parents to offspring are not often considered within the evolutionary theory of ageing. Here, we show the 25% memory impairment in Drosophila melanogaster offspring solely dependent on the age of the parents and also passed on to the F2 generation. Furthermore, this parental age effect was not attributed to a generalized reduction in condition of the offspring but was specific to short-term memory. We also provide evidence implicating oxidative stress as a causal factor by showing that lines selected for resistance to oxidative stress did not display a memory impairment in offspring of old parents. The identification of the parental age-related memory impairment in a model system should stimulate integration between mechanistic studies of age-related mortality risk and functional studies of parental age effects on the fitness of future generations.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
38Psychiatr Prax 2010 Jan 37: 34-42
PMID20072988
Title[The regional psychiatry budget (RPB): a model for a new payment system of hospital based mental health care services].
AbstractTo analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) on costs and effectiveness of care.
Patients with a diagnosis according to ICD-10 F10, F2 or F3 were interviewed in the model region (MR, n = 258) and a control region (CR, n = 244) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HoNOS, SCL-90R, PANSS, BRMAS / BRMES), functioning (GAF, SOFAS) and quality of life (WHOQOL-BREF, EQ-5D). Use of care was determined semi-annually.
There were no significant differences in the development of psychopathology and quality of life between MR and CR. In the MR, functioning of patients with schizophrenia and affective disorders improved significantly more strongly. The development of total mental health care costs was not different between MR and CR. However, the costs of office based mental health care increased slightly more strongly in the MR, indicating a small cost-shift from the RPB to extrabudgetary financed services.
The RPB showed slight advantages regarding the effectiveness of care and did not significantly change the total mental health care costs.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
39Acta Neuropsychiatr 2010 Dec 22: 284-91
PMID25385215
TitlePrematurity and low birth weight as risk factors for the development of affective disorder, especially depression and schizophrenia: a register study.
AbstractLarsen JK, Bendsen BB, Foldager L, Munk-Jørgensen P. Prematurity and low birth weight as risk factors for the development of affective disorder, especially depression and schizophrenia: a register study.
The present study examined whether low birth weight, prematurity or low birth weight adjusted for gestational age are risk factors for the subsequent development of affective disorder, especially depression.
A population-based case-control design was applied to the Danish Medical Birth Register and the Danish Psychiatric Central Register to identify all individuals born between 1 January 1974 and 31 December 1990 and diagnosed prior to 29 August 2003 with affective disorder alone (ICD-10 F3; 4297 females, 1861 males), schizophrenia alone (ICD-10 F2; 1364 females, 2292 males) or both disorders (ICD-10 F3 + F2; 450 females, 405 males). The association between low birth weight and the risk of developing affective disorder and/or schizophrenia was analysed by conditional logistic regression analysis.
Low birth weight was found to be associated with a significantly elevated risk of developing schizophrenia alone (p = 0.021) and both affective disorder and schizophrenia (p = 0.024), and a non-significantly elevated risk of developing affective disorder alone (p = 0.063). The effect remained significant in the affective disorder and schizophrenia groups (p = 0.039) when correcting for gestational age (premature birth), but was lost in the group with both disorders. Premature birth per se was found to be associated with a significantly elevated risk of developing both affective disorder and schizophrenia (p = 0.00018), an effect that remained significant after adjustment for low birth weight.
Prematurity and low birth weight were found to be risk factors for subsequent development of affective disorder (especially depression) and schizophrenia.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
40Neuropsychiatr 2010 -1 24: 195-9
PMID20926058
Title[Quality assurance of take-over from in-patient to out-patient care: experiences in Lower Austria].
AbstractCommunity mental health teams (CMHT) provide support for severely disabled, chronic mentally ill patients. In this study, referrals to CMHT by a psychiatric hospital in Lower Austria were analysed, as were the first few weeks of care for referred patients.
Referrals to CMHT of a catchment area (pop 250.000) were analysed for 2002- 2006.
In the first 6 months of each year, 124 to 189 patients were referred to CMHT. Between 2002 and 2006, the percentage of affective disorders (ICD-10: F3: 40.0 %), and substance use disorders (F1: 38.9 %) within the referrals diminished, as compared to patients suffering from schizophrenia (F2 initially 25.4 % of referrals vs. 49.7 %) and personality disorders (F6 initially 6.4 % of referrals vs. 22.4 %). In 30.7 % vs. 56.6 % of patients, CMHT workers managed to establish contact to patients after discharge from hospital. They actively sought contact with 39.9 to 74.6 % of referred patients (by means of telephone calls, letters, home visits, etc.). In 26.5 to 46.9 % of the referrals, continuous care was planned.
This study emphasizes the advantage of specific referrals to CMHT, if care for severely disabled individuals is needed and should be provided. Furthermore, a description of outreach activities, which are intended to maintain contact with patients characterized by poor compliance, is presented. These activities are not yet part of routine care in German speaking countries.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
41J. Neurosci. 2011 Aug 31: 11748-55
PMID21849535
TitleEarly prenatal stress epigenetically programs dysmasculinization in second-generation offspring via the paternal lineage.
AbstractStudies have linked sex-biased neurodevelopmental disorders, including autism and schizophrenia, with fetal antecedents such as prenatal stress. Further, these outcomes can persist into subsequent generations, raising the possibility that aspects of heritability in these diseases involve epigenetic mechanisms. Utilizing a mouse model in which we previously identified a period in early gestation when stress results in dysmasculinized and stress-sensitive male offspring, we have examined programming effects in second-generation offspring of prenatally stressed (F2-S) or control (F2-C) sires. Examination of gene expression patterns during the perinatal sensitive period, when organizational gonadal hormones establish the sexually dimorphic brain, confirmed dysmasculinization in F2-S males, where genes important in neurodevelopment showed a female-like pattern. Analyses of the epigenomic miRNA environment detected significant reductions in miR-322, miR-574, and miR-873 in the F2-S male brain, levels that were again more similar to those of control females. Increased expression of a common gene target for these three miRNAs, ?-glycan, was confirmed in these males. These developmental effects were associated with the transmission of a stress-sensitive phenotype and shortened anogenital distance in adult F2-S males. As confirmation that the miRNA environment is responsive to organizational testosterone, neonatal males administered the aromatase inhibitor formestane exhibited dramatic changes in brain miRNA patterns, suggesting that miRNAs may serve a previously unappreciated role in organizing the sexually dimorphic brain. Overall, these data support the existence of a sensitive period of early gestation when epigenetic programming of the male germline can occur, permitting transmission of specific phenotypes into subsequent generations.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
42Nord J Psychiatry 2011 Dec 65: 381-8
PMID21438790
TitleDiagnostic stability over 2 years in patients with acute and transient psychotic disorders.
AbstractThe nosological entity of acute and transient psychotic disorders (ATPD) as an independent diagnostic category has become a subject of controversial opinions. The present study aimed to follow-up the diagnostic stability of index episode of ATPD and to examine the influence of clinical and socio-demographic factors on the ATPD prognosis.
A sample of 153 (60.1% females; mean age 27.8 ± 8.2) first-admitted patients with ATPD was followed over 2 years. The clinical manifestations, global functioning and quality of life were regularly evaluated during follow-up period.
At the end of follow-up, the overall stability rate of ATPD, excluding the cases not readmitted until last assessment, reached 34%. The diagnostic transition was observed in 35.9% of the patients, mostly to schizophrenia and schizoaffective disorders. There was a significant deterioration in several clinical and social indicators among the patients who developed schizophrenia, compared with those with stable ATPD, whereas no reliable predictors were found for diagnostic transition to schizophrenia, except younger age, unmarried status and period of the first hospitalization.
A sizeable proportion of the patients with initial diagnosis of ATPD is likely to represent early manifestations of schizophrenia-related disorders. In agreement with some previous observations, our study indicates a lack of strong rationale for separating ATPD from other psychotic disorders within the ICD-10 F2 category.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
43Psychiatry Res 2011 Jan 185: 261-8
PMID20537717
TitleAccuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.
AbstractAssessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
44Psychiatry Res 2011 Jan 185: 261-8
PMID20537717
TitleAccuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.
AbstractAssessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
45Schizophr Bull 2012 May 38: 622-9
PMID21134974
TitleImpaired associative inference in patients with schizophrenia.
AbstractThe ability to learn, store, and retrieve information about relationships is impaired in schizophrenia. Here, we tested 38 control and 61 schizophrenia subjects for their ability to identify the novel pairing of stimuli, based on associations learned during training. Subjects were trained on 3 sets of paired associates: 30 face-house pairs (H-F1), 30 face-house pairs (H-F2, same house with new face), and 30 face-face pairs (F3-F4). After training, participants were tested on the 3 explicitly trained pair types, as well as 30 new face-face pairs (F1-F2), which could only be linked together via the same house during the H-F1/H-F2 training blocks. Of 99 subjects tested, 37 patients with schizophrenia and 36 age-matched healthy control subjects learned the premise pairs and performed the relational memory test. Healthy control subjects were significantly more accurate in identifying the inferential (F1-F2) pairs than the noninferential (F3-F4) pairs. In contrast, schizophrenia patients were equally accurate on inferential and noninferential pairs, providing evidence for a relational memory deficit in schizophrenia. However, the current version of the associative inference paradigm, suggested by the Cognitive Neuroscience Treatment Research to Improve Cognition in schizophrenia initiative, has limited feasibility, calling into question the generalizability of the findings for the larger schizophrenia population.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
46Schizophr. Res. 2012 Dec 142: 31-9
PMID23127379
TitleCharacteristics of suicide attempts in patients diagnosed with schizophrenia in comparison with depression: a study of emergency room visit cases in Japan.
AbstractWe worked on characterizing suicide attempts in patients with schizophrenia in comparison with mood disorders. This study population comprised 260 patients with F2 disorders (ICD-10), i.e., "schizophrenic group" and 705 patients with F3 disorders, i.e., "depressive group" who presented at the psychiatric emergency department of our hospital for 8 years. They were compared in three age groups: young (?24 years), middle-aged (25-44 years), and elderly (?45 years). Multivariate logistic regression analysis identified factors associated with the seriousness of the suicide attempt method. The schizophrenic group (?25 years) had a younger mean age and higher prevalences of "within-1-year suicide attempts" and "past suicide attempts" than the depressive group. The schizophrenic group tended to use serious methods, such as "jumping from high places," "throwing oneself in front of an oncoming train," and "burning oneself," in their suicide attempts, with "hallucination-delusion" accounting for an overwhelmingly large percentage of suicide attempt motives, irrespective of the age group. In the elderly group, the ratio of "no-housemate" patients was high. In all age groups, jobless individuals were prevalent, and the schizophrenic group had lower LCU (Life Change Unit) scores than did the depressive group. The middle-aged cases of schizophrenic group had higher BPRS (Brief Psychiatric Rating Scale) scores and lower GAS (Global Assessment Scale) scores. Regarding factors influencing the seriousness of the methods, a history of within-1-year suicide attempts increased the method seriousness in the schizophrenic group. Years of education correlated with the method seriousness in the schizophrenic group. Low scores of overall health on the GAS increased the method seriousness in both groups.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
47Schizophr. Res. 2012 Dec 142: 31-9
PMID23127379
TitleCharacteristics of suicide attempts in patients diagnosed with schizophrenia in comparison with depression: a study of emergency room visit cases in Japan.
AbstractWe worked on characterizing suicide attempts in patients with schizophrenia in comparison with mood disorders. This study population comprised 260 patients with F2 disorders (ICD-10), i.e., "schizophrenic group" and 705 patients with F3 disorders, i.e., "depressive group" who presented at the psychiatric emergency department of our hospital for 8 years. They were compared in three age groups: young (?24 years), middle-aged (25-44 years), and elderly (?45 years). Multivariate logistic regression analysis identified factors associated with the seriousness of the suicide attempt method. The schizophrenic group (?25 years) had a younger mean age and higher prevalences of "within-1-year suicide attempts" and "past suicide attempts" than the depressive group. The schizophrenic group tended to use serious methods, such as "jumping from high places," "throwing oneself in front of an oncoming train," and "burning oneself," in their suicide attempts, with "hallucination-delusion" accounting for an overwhelmingly large percentage of suicide attempt motives, irrespective of the age group. In the elderly group, the ratio of "no-housemate" patients was high. In all age groups, jobless individuals were prevalent, and the schizophrenic group had lower LCU (Life Change Unit) scores than did the depressive group. The middle-aged cases of schizophrenic group had higher BPRS (Brief Psychiatric Rating Scale) scores and lower GAS (Global Assessment Scale) scores. Regarding factors influencing the seriousness of the methods, a history of within-1-year suicide attempts increased the method seriousness in the schizophrenic group. Years of education correlated with the method seriousness in the schizophrenic group. Low scores of overall health on the GAS increased the method seriousness in both groups.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
48Schizophr. Res. 2012 Dec 142: 93-5
PMID23102940
TitlePhonetic measures of reduced tongue movement correlate with negative symptom severity in hospitalized patients with first-episode schizophrenia-spectrum disorders.
AbstractAprosody, or flattened speech intonation, is a recognized negative symptom of schizophrenia, though it has rarely been studied from a linguistic/phonological perspective. To bring the latest advances in computational linguistics to the phenomenology of schizophrenia and related psychotic disorders, a clinical first-episode psychosis research team joined with a phonetics/computational linguistics team to conduct a preliminary, proof-of-concept study.
Video recordings from a semi-structured clinical research interview were available from 47 first-episode psychosis patients. Audio tracks of the video recordings were extracted, and after review of quality, 25 recordings were available for phonetic analysis. These files were de-noised and a trained phonologist extracted a 1-minute sample of each patient's speech. WaveSurfer 1.8.5 was used to create, from each speech sample, a file of formant values (F0, F1, F2, where F0 is the fundamental frequency and F1 and F2 are resonance bands indicating the moment-by-moment shape of the oral cavity). Variability in these phonetic indices was correlated with severity of Positive and Negative Syndrome Scale negative symptom scores using Pearson correlations.
A measure of variability of tongue front-to-back position-the standard deviation of F2-was statistically significantly correlated with the severity of negative symptoms (r=-0.446, p=0.03).
This study demonstrates a statistically significant and meaningful correlation between negative symptom severity and phonetically measured reductions in tongue movements during speech in a sample of first-episode patients just initiating treatment. Further studies of negative symptoms, applying computational linguistics methods, are warranted.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
49Neuropsychology 2012 Jul 26: 451-8
PMID22612578
TitleRevised associative inference paradigm confirms relational memory impairment in schizophrenia.
AbstractPatients with schizophrenia have widespread cognitive impairments, with selective deficits in relational memory. We previously reported a differential relational memory deficit in schizophrenia using the Associative Inference Paradigm (AIP), a task suggested by the Cognitive Neuroscience Treatment Research to Improve Cognition in schizophrenia (CNTRICS) initiative to examine relational memory. However, the AIP had limited feasibility for testing in schizophrenia because of high attrition of schizophrenia patients during training. Here we developed and tested a revised version of the AIP to improve feasibility.
30 healthy control and 37 schizophrenia subjects received 3 study-test sessions on 3 sets of paired associates: H-F1 (house paired with face), H-F2 (same house paired with new face), and F3-F4 (two novel faces). After training, subjects were tested on the trained, noninferential Face-Face pairs (F3-F4) and novel, inferential Face-Face pairs (F1-F2), constructed from the faces of the trained House-Face pairs.
schizophrenia patients were significantly more impaired on the inferential F1-F2 pairs than the noninferential F3-F4 pairs, providing evidence for a differential relational memory deficit. Only 8% of schizophrenia patients were excluded from testing because of poor training performance.
The revised AIP confirmed the previous finding of a relational memory deficit in a larger and more representative sample of schizophrenia patients.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
50Prog. Neuropsychopharmacol. Biol. Psychiatry 2013 Oct 46: 200-6
PMID23470289
TitleFree radicals, antioxidant defense systems, and schizophrenia.
AbstractThe etiopathogenic mechanisms of schizophrenia are to date unknown, although several hypotheses have been suggested. Accumulating evidence suggests that excessive free radical production or oxidative stress may be involved in the pathophysiology of schizophrenia as evidenced by increased production of reactive oxygen or decreased antioxidant protection in schizophrenic patients. This review aims to summarize the basic molecular mechanisms of free radical metabolism, the impaired antioxidant defense system and membrane pathology in schizophrenia, their interrelationships with the characteristic clinical symptoms and the implications for antipsychotic treatments. In schizophrenia, there is accumulating evidence of altered antioxidant enzyme activities and increased levels of lipid peroxidation, as well as altered levels of plasma antioxidants. Moreover, free radical-mediated abnormalities may contribute to specific aspects of schizophrenic symptomatology and complications of its treatment with antipsychotic drugs, as well as the development of tardive dyskinesia (TD). Finally, the potential therapeutic strategies implicated by the accumulating data on oxidative stress mechanisms for the treatment of schizophrenia are discussed.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
51Prog. Neuropsychopharmacol. Biol. Psychiatry 2013 Oct 46: 200-6
PMID23470289
TitleFree radicals, antioxidant defense systems, and schizophrenia.
AbstractThe etiopathogenic mechanisms of schizophrenia are to date unknown, although several hypotheses have been suggested. Accumulating evidence suggests that excessive free radical production or oxidative stress may be involved in the pathophysiology of schizophrenia as evidenced by increased production of reactive oxygen or decreased antioxidant protection in schizophrenic patients. This review aims to summarize the basic molecular mechanisms of free radical metabolism, the impaired antioxidant defense system and membrane pathology in schizophrenia, their interrelationships with the characteristic clinical symptoms and the implications for antipsychotic treatments. In schizophrenia, there is accumulating evidence of altered antioxidant enzyme activities and increased levels of lipid peroxidation, as well as altered levels of plasma antioxidants. Moreover, free radical-mediated abnormalities may contribute to specific aspects of schizophrenic symptomatology and complications of its treatment with antipsychotic drugs, as well as the development of tardive dyskinesia (TD). Finally, the potential therapeutic strategies implicated by the accumulating data on oxidative stress mechanisms for the treatment of schizophrenia are discussed.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
52J Abnorm Psychol 2013 Nov 122: 1179-88
PMID24364619
TitleNeuropsychological functioning and severity of ADHD in early childhood: a four-year cross-lagged study.
AbstractChildren with attention deficit/hyperactivity disorder (ADHD) have poorer neuropsychological functioning relative to their typically developing peers. However, it is unclear whether early neuropsychological functioning predicts later ADHD severity and/or the latter is longitudinally associated with subsequent neuropsychological functioning; and whether these relations are different in children with and without early symptoms of ADHD. This study aimed to examine the longitudinal associations between ADHD severity and neuropsychological functioning among children at high and low risk of developing ADHD. Hyperactive/Inattentive (H/I; n = 140) and Typically developing (TD; n = 76) preschoolers (age 3-4 years) were recruited (BL) and followed annually for 3 years (F1, F2, and F3). Teachers rated the children's ADHD severity and impairment using the Behavior Assessment System for Children-2 and the Children's Problem Checklist, respectively. Parent reports of children's ADHD severity were obtained using the Kiddie-Schedule for Affective Disorders and schizophrenia - Present and Lifetime version. Neuropsychological functioning was assessed using the NEPSY. In the full sample, there were bidirectional longitudinal associations between neuropsychological functioning and ADHD severity between F1 and F3. Among H/I children, neuropsychological functioning at F1 and F2 predicted ADHD severity at F2 and F3, respectively. In contrast, among TD children the only significant relationship observed was that elevated ADHD symptoms at F2 were associated with poorer neuropsychological functioning at F3. Improved neuropsychological functioning may attenuate ADHD symptoms and associated impairment among H/I children during the early school years. Interventions designed to improve neuropsychological functioning among young H/I children may be beneficial in reducing their ADHD severity.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
53Front Psychiatry 2013 -1 4: 116
PMID24130534
TitleEfficacy of community treatments for schizophrenia and other psychotic disorders: a literature review.
AbstractIn Chile, the clinical guidelines "for the treatment of people from first episode of schizophrenia" aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals.
This study compiles and synthesizes available scientific evidence from the last 14?years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders.
An electronic search was carried out using PUBMED, LILACS, and Science Direct as databases. Criteria of inclusion: (i) randomized clinical trials, (ii) Community-based interventions, (iii) diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10).
(i) treatments exclusively pharmacological, (ii) interventions carried out in inpatient settings, (iii) bipolar affective disorder or substance-induced psychosis (greater than 50% of sample).
Sixty-six articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status.
Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
54J Clin Psychiatry 2013 May 74: e439-44
PMID23759464
TitleReduction of crime in first-onset psychosis: a secondary analysis of the OPUS randomized trial.
AbstractViolence and criminality are adverse outcomes for some persons who develop psychotic illnesses. The extent to which treatment can reduce offending has rarely been studied. The aim of this study was to evaluate whether assertive specialized treatment would reduce the rate of crime in patients with a first episode of psychotic illness.
From January 1998 to December 2000, a total of 547 patients aged 18-45 years with a first episode of schizophrenia spectrum disorder (ICD-10 diagnostic code within F2) were randomized to assertive specialized treatment or standard treatment in an outpatient setting. In the current secondary analysis of the data, levels of criminality during the 2-year treatment period and the 3 years following were assessed using official records from Danish registers. Main outcome measures were any offending and violent offending.
No significant reduction in violent offending or any offending was found in the assertive specialized treatment group (adjusted hazard ratio = 1.06; 95% CI, 0.72-1.56) compared with the control group. Prevalence of offending was low and had often commenced prior to inclusion in the trial.
While assertive specialized treatment has shown good treatment effects, it had no impact on rates of offending, thereby calling into question the potential efficacy of universally applied improvements in outpatient services with respect to reducing crime and violence. More specific interventions that address criminogenic needs in a more narrowly defined group of high-risk patients may be considered.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
55Prog. Neuropsychopharmacol. Biol. Psychiatry 2013 Jul 44: 290-5
PMID23583772
TitleAssociation of serotonin transporter gene (SLC6A4) polymorphisms with schizophrenia susceptibility and symptoms in a Chinese-Han population.
Abstractschizophrenia (SZ) is a complex psychiatric disorder with a strong genetic component. The serotonin transporter (SERT), encoded by solute carrier family 6 member 4 (SLC6A4), regulates synaptic concentrations of serotonin and thereby strongly influences perception, mood, emotion, behavior, and cognition, all of which are severely disturbed in SZ. Two variable numbers of tandem repeat (VNTR) polymorphisms and several single nucleotide polymorphisms (SNPs) spread throughout SLC6A4 are involved in both neuropsychiatric diseases (including SZ) and personality traits. In this study, case-control association analysis was performed in the Chinese-Han population to identify additional allelic variants of the SLC6A4 gene that may confer susceptibility to SZ. Ten relatively common SNPs (minor allele frequency >5%) were genotyped in 528 paranoid SZ patients and 528 control subjects. Significant associations were found between SZ and the allele and genotypic frequencies of rs140700G/A (p=2.45×10(-12), 2.34×10(-11), respectively). The frequency of the A allele was lower in SZ patients (17.7%) than in controls (30.9%; OR=1.93, 95%CI=1.58-2.36). In five factor analysis of the positive and negative syndrome scale (PANSS) scores of first episode SZ patients, mean negative factor score (F2,249=3.986, p=0.02) and depression/anxiety factor score (F2, 249=8.766, p=2.11×10(-4)) were significantly different among the rs140700G/A genotypes, with both scores higher for genotype AA than AG+GG. The rs140700G/A allele of SLC6A4 is strongly associated with SZ susceptibility and symptom expression in the Chinese-Han population.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
56Psychiatr Prax 2013 Jan 40: 43-8
PMID23319283
Title[Religious and spiritual attitudes of patients with schizophrenic or affective disorders].
AbstractIn psychiatry and psychotherapy religion and spirituality were for a long time mainly considered as a pathological and neurotic phenomenon. Nowadays they are increasingly accepted as an independent dimension and resource.
By means of a questionnaire, inpatients of 3 hospitals with schizophrenic (F2) or affective (F3) disorders were interviewed shortly before discharge about their religious and spiritual attitude with regard to therapy, coping with psychiatric disorder and hospital based pastoral care. General religiousness of the participants was measured using the centrality scale of the Structure of Religiosity Test.
Of the 216 participants 25% rated themselves as not religious, 61% as religious, and 14% as highly religious. Diagnosis, education, sex, duration of illness and self-evaluation of current mental health status had no significant statistical impact on the importance of religion. Higher age and importance of religion were positively correlated. Hospital based pastoral services were perceived as very helpful. Results indicate positive effects of religiousness on coping with the psychiatric disorder.
For three of four patients religion and spirituality play a more or less important role in their life. In a clinical as well as in a scientific context this dimension should be paid more regard in psychiatry and psychotherapy.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
57Soc Psychiatry Psychiatr Epidemiol 2013 Aug 48: 1283-8
PMID23515714
TitleAssessment of cardiovascular disease risk in patients with schizophrenia spectrum disorders in German psychiatric hospitals: results of the pharmacoepidemiologic CATS study.
AbstractPatients with severe mental illness are at high risk for metabolic and cardiac disorders. Thus, monitoring of cardiovascular risks is imperative and schedules for screening for lipids, glucose, body mass index (BMI), waist-hip ratio and blood pressure have been developed. We intended to analyze screening for metabolic disorders in German patients with schizophrenia spectrum disorders in routine psychiatric care.
We included 674 patients with any F2 diagnosis in out- and inpatient settings and analyzed metabolic screening procedures as practiced under conditions of usual care.
Except BMI (54 %), all other values were documented only in a minority of patients: waist circumference (23 %), cholesterol (28 %), fasting glucose (19 %), triglycerides (25 %) and blood pressure (37 %). We found evidence for less than perfect quality of blood pressure measures. The group of patients who met the individual metabolic syndrome ATP III criteria was comparable to the US CATIE trial.
We conclude that frequency and quality of metabolic monitoring in German in- and outpatients settings are not in accordance with the respective recommendations. Similar to previous reports we found evidence for a high prevalence of metabolic disturbances in German patients with schizophrenia spectrum disorders.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
58Aust N Z J Psychiatry 2013 Mar 47: 250-8
PMID23076547
TitleCultural diversity in physical diseases among patients with mental illnesses.
AbstractPeople with psychiatric diseases have a severely increased risk for physical morbidity and premature death from physical diseases. The aims of the study were to investigate the occurrence of cardiovascular diseases (CVD), diabetes (DM) and obesity in schizophrenia and depression in three different geographical areas - Asia (Japan), Africa (Nigeria) and Western Europe (Switzerland, Germany and Denmark) - and to search for possible transcultural differences in these correlations, which would also reflect the differences between low-income areas in Africa (Nigeria) and high-income areas in Europe and Japan.
Patients with International Classification of Diseases (ICD-10) F2 diseases (schizophrenia spectrum disorders) and F3 diseases (affective disorders) admitted to one Nigerian, one Japanese, two Swiss, two German and six Danish centres during 1 year were included. Physical diseases in accordance with ICD-10 were also registered. Psychiatric and physical comorbidity were calculated and standardized rate ratio incidences of background populations were our primary measures.
Incidence rate ratios were increased for both CVD, DM and overweight in both F2 and F3 in all cultures (Western Europe, Nigeria and Japan) within the same ranges (however, the Japanese results should be interpreted conservatively owing to the limited sample size). Overweight among the mentally ill were marked in Nigeria. A parallelism of the incidence of overweight, CVD and diabetes with the occurrence in background populations was seen and was most marked in overweight.
Overweight, CVD and DM were increased in schizophrenia spectrum disorders and affective disorders in all three cultures investigated (Western Europe, Nigeria and Japan). Lifestyle diseases were also seen in Nigeria and Japan. The results from this study indicate that cultural background might be seen as an important factor in dealing with lifestyle diseases among people with a severe mental illness, as it is in the general population.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
59Nervenarzt 2013 Mar 84: 315-25
PMID22476511
Title[Substance use associated disorders: frequency in patients with schizophrenic and affective psychoses].
AbstractAlcohol and substance use disorders (ASUD) are considered to be among the most frequent comorbidities in schizophrenic and affective psychoses and have a significant negative influence on their course and prognosis. In the present study patients with diagnosis from the ICD-10 category F2 or F3 were examined regarding a substance use disorder in a multicentre cross-section evaluation at nine psychiatric hospitals in Baden-Württemberg. The aim of this study is to discuss the current research on substance use disorders and psychosis comorbidity regarding the theoretical models by means of collected data.
The examination of 50 consecutive admissions per centre is based on a shortened version of the European Severity Index (Europ ASI). An initial urine drug screening was carried out with all patients after admission. Statistical assessment was based on percentage distributions, mean values, standard deviations and suitable correlation analysis.
The representative sample included 448 patients. A proportion of 169 patients (37.7%) had a dual diagnosis F2 and F1 and a proportion of 144 patients (32.1%) had a dual diagnosis F3 and F1; 64 patients (14.3%) had an F2 diagnosis and 71 patients (15.8%) had an F3 diagnosis without ASUD. Apart from lifetime use of alcohol (n?=?268) and tobacco (n?=?325) hypnotics/tranquilizers (n?=?214), cannabis (n?=?156), opioids (n?=?71), stimulants (n?=?96) and hallucinogens (n?=?36) were consumed. The most frequent combination and long-term intake consisted of tobacco, alcohol, hypnotics/tranquilizer, cannabis and psychostimulants especially in men with schizophrenic disorders. Regarding motivation before first substance use general psychological adjustment disorders (51%), peer impact (42%) and unspecific affective symptoms were predominant.
Altogether the present study clearly demonstrates that patients suffering from schizophrenia, affective disorders and ASUD have significantly higher rates of more severe substance use disorders in their psychosocial environment and more suicidal behaviour than patients without substance misuse. The high rate in the cross-sectional prevalence of tobacco, alcohol, cannabis and psychostimulant use calls for more effective drug prevention.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
60Nervenarzt 2013 Mar 84: 315-25
PMID22476511
Title[Substance use associated disorders: frequency in patients with schizophrenic and affective psychoses].
AbstractAlcohol and substance use disorders (ASUD) are considered to be among the most frequent comorbidities in schizophrenic and affective psychoses and have a significant negative influence on their course and prognosis. In the present study patients with diagnosis from the ICD-10 category F2 or F3 were examined regarding a substance use disorder in a multicentre cross-section evaluation at nine psychiatric hospitals in Baden-Württemberg. The aim of this study is to discuss the current research on substance use disorders and psychosis comorbidity regarding the theoretical models by means of collected data.
The examination of 50 consecutive admissions per centre is based on a shortened version of the European Severity Index (Europ ASI). An initial urine drug screening was carried out with all patients after admission. Statistical assessment was based on percentage distributions, mean values, standard deviations and suitable correlation analysis.
The representative sample included 448 patients. A proportion of 169 patients (37.7%) had a dual diagnosis F2 and F1 and a proportion of 144 patients (32.1%) had a dual diagnosis F3 and F1; 64 patients (14.3%) had an F2 diagnosis and 71 patients (15.8%) had an F3 diagnosis without ASUD. Apart from lifetime use of alcohol (n?=?268) and tobacco (n?=?325) hypnotics/tranquilizers (n?=?214), cannabis (n?=?156), opioids (n?=?71), stimulants (n?=?96) and hallucinogens (n?=?36) were consumed. The most frequent combination and long-term intake consisted of tobacco, alcohol, hypnotics/tranquilizer, cannabis and psychostimulants especially in men with schizophrenic disorders. Regarding motivation before first substance use general psychological adjustment disorders (51%), peer impact (42%) and unspecific affective symptoms were predominant.
Altogether the present study clearly demonstrates that patients suffering from schizophrenia, affective disorders and ASUD have significantly higher rates of more severe substance use disorders in their psychosocial environment and more suicidal behaviour than patients without substance misuse. The high rate in the cross-sectional prevalence of tobacco, alcohol, cannabis and psychostimulant use calls for more effective drug prevention.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
61PLoS ONE 2014 -1 9: e96272
PMID24809694
TitleCharacteristics of attempted suicide by patients with schizophrenia compared with those with mood disorders: a case-controlled study in northern Japan.
AbstractRecent reports suggest a lifetime suicide risk for schizophrenia patients of approximately 5%. This figure is significantly higher than the general population suicide risk consequently, detection of those at risk is clinically important. This study was undertaken to define the characteristics of suicide attempts by schizophrenia patients compared with attempts by patients with mood disorders. All patients were diagnosed using the ICD-10 criteria. The study population comprised 65 patients with F2 disorders (schizophrenia, schizotypal and delusional disorders), i.e., "the F2 group", and 94 patients with F3 disorders (mood disorders), i.e., "the F3 group", who presented in the clinical setting of consultation-liaison psychiatry. The F2 group had a significantly younger mean age and significantly higher ratios of 'past/present psychiatric treatment' and 'more than 3 months interruption of psychiatric treatment'. In contrast, the ratios of 'physical disorder comorbidity', 'alcohol intake at suicide attempt' and 'suicide note left behind' were significantly higher in the F3 group. The F2 group attempted suicide by significantly more serious methods. Furthermore, 'hallucination-delusion' was the most prevalent motive in the F2 group and was the only factor that showed a significant association with the seriousness of the method of suicide attempt (OR?=?3.36, 95% CI: 1.05-11.33).
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
62Gesundheitswesen 2014 Feb 76: 86-95
PMID23737155
Title[Cost evaluation of a model for integrated care of seriously mentally ill patients].
AbstractThe model for integrated care (IC) of those seriously mentally ill patients insured with the DAK-Gesundheit health insurance and various Betriebskrankenkassen (members of the VAG Mitte) from the regions Berlin, Brandenburg, Lower Saxony and Bremen allows a complex treatment in the outpatient setting which consists of psychiatrists, general practitioners and clinicians, psychiatric nursing, sociotherapy (only in Berlin), internal medicine quality circles, orientation on treatment guidelines and conceptual consensus with the relevant care clinics. The aim of the evaluation is to illustrate the health economic effects of IC.
In the period from 2006 to 2010 insured members of the DAK-Gesundheit and other involved health insurance companies with a serious mental illness, a significant impairment of social functioning and the need to be treated to avoid or substitute an in-hospital stay were included in the integrated care. The cost perspective was that of the statutory health insurance companies. For the health economic evaluation, the utilisation of continuous IC over 18 months was compared to the last 18 months prior to the inclusion in IC. The clinical findings were gathered quarterly during the IC using CGI (Clinical Global Impressions) and GAF (Global Assessment of Functioning Scale).
A total of 1 364 patients receiving IC in 66 doctor's practices were documented (of those, 286 had diagnoses of ICD-10 F2, 724 ICD-10 F32-F39). The median age was 48.8 years, 69% were female. 24% had their own source of income, 40% were on the pension, and the rest of the patients were receiving transfer benefits in some form. In 54% of the cases IC was used to avoid an in-hospital stay, in 46% of the cases to substitute an in-hospital stay. The degree of the CGI was 5.5 on average at the time of inclusion and the GAF score was 36.5 on average. The 226 patients with continuous documentation over 18 months were included in the health economic analysis. The number of days spent in hospital was lower during the IC period as compared to the 18 months prior to IV (11.8 vs. 28.6 days, p<0.001), the inpatient costs were lower (5 929 ± 13 837 Euro vs. 2 458 ± 6 940 Euro, p<0.001), the total was not significantly changed (7 777 ± 14 263 Euro vs. 7 321 ± 7 910 Euro, p=0.65). The substantial reduction of inpatient costs was compensated by the additional costs for medication and the costs of the complex outpatient care. Results were comparable for the 2 subgroups of schizophrenic/schizoaffective (n=66, 40.9 vs. 17.9 days, p=0.03; inpatient cost 9 009 ± 15 677 Euro vs. 3 650 ± 8 486 Euro, p=0.02; total expenditures 11 789 ± 15 975 Euro vs. 9 623 ± 9 262 Euro, p=0.33) and unipolar depressive patients (n=90, 29.8 vs. 9.8 days, p=0.006; inpatient cost 5 664 ± 14 921 Euro vs. 1 967 ± 5 276 Euro, p=0.02; total expenditures 7 146 ± 15 164 Euro vs. 6 234 ± 6 292 Euro, p=0.57).
The IC was able to considerably reduce the utilisation of inpatient treatment through offering a complex range of services in the outpatient setting and allowed for a weight-shift in a low-threshold comprehensive care structure without an increase in costs from the statutory health insurance companies' perspective. For a detailed description of clinical effects further studies are required.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
63PLoS ONE 2014 -1 9: e96272
PMID24809694
TitleCharacteristics of attempted suicide by patients with schizophrenia compared with those with mood disorders: a case-controlled study in northern Japan.
AbstractRecent reports suggest a lifetime suicide risk for schizophrenia patients of approximately 5%. This figure is significantly higher than the general population suicide risk consequently, detection of those at risk is clinically important. This study was undertaken to define the characteristics of suicide attempts by schizophrenia patients compared with attempts by patients with mood disorders. All patients were diagnosed using the ICD-10 criteria. The study population comprised 65 patients with F2 disorders (schizophrenia, schizotypal and delusional disorders), i.e., "the F2 group", and 94 patients with F3 disorders (mood disorders), i.e., "the F3 group", who presented in the clinical setting of consultation-liaison psychiatry. The F2 group had a significantly younger mean age and significantly higher ratios of 'past/present psychiatric treatment' and 'more than 3 months interruption of psychiatric treatment'. In contrast, the ratios of 'physical disorder comorbidity', 'alcohol intake at suicide attempt' and 'suicide note left behind' were significantly higher in the F3 group. The F2 group attempted suicide by significantly more serious methods. Furthermore, 'hallucination-delusion' was the most prevalent motive in the F2 group and was the only factor that showed a significant association with the seriousness of the method of suicide attempt (OR?=?3.36, 95% CI: 1.05-11.33).
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
64Int J Soc Psychiatry 2015 Aug 61: 456-64
PMID25300671
TitleWhere are patients who have co-occurring mental and physical diseases located?
AbstractPatients with a psychiatric illness have a higher prevalence of physical diseases and thus a higher morbidity and mortality.
The main aim was to investigate where patients with co-occurring physical diseases and mental disorders (psychotic spectrum or mood) in the health and social service system are identified most frequently before admission into psychiatry. The second aim was to compare the differences in the treatment routes taken by the patients before entry into psychiatric services in all the participating countries (Denmark, Germany, Japan, Nigeria and Switzerland).
On admission to a psychiatric service, patients diagnosed with schizophrenia, schizotypal or delusional disorders (International Classification of Diseases-10 (ICD-10) group F2) or mood (affective) disorders (ICD-10 group F3) and a co-morbid physical condition (cardiovascular disease, diabetes mellitus and overweight) were asked with which institutions or persons they had been in contact with in the previous 6 months.
Patients from Denmark, Germany and Switzerland with mental disorders had almost the same contact pattern. Their primary contact was to public or private psychiatry, with a contact percentage of 46%-91%; in addition, general practice was a common contact, with a margin of 41%-93%. Similar tendencies are seen in Japan despite the small sample size. With regard to general practice, this is also the case with Nigerian patients. However, religious guidance or healing was rarely sought by patients in Europe and Japan, while in Nigeria about 80% of patients with mental disorders had contacted this type of service.
Promoting prophylactic work between psychiatry and the general practice sector may be beneficial in diminishing physical conditions such as cardiovascular disease, diabetes mellitus and overweight in patients with mental disorders in European countries and Japan. In Nigeria (a low-to-middle-income country), religious guides or healers, along with general practitioners, are the most frequently contacted, and they therefore seem to be the most obvious partner to collaborate with.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
65Int J Soc Psychiatry 2015 Aug 61: 456-64
PMID25300671
TitleWhere are patients who have co-occurring mental and physical diseases located?
AbstractPatients with a psychiatric illness have a higher prevalence of physical diseases and thus a higher morbidity and mortality.
The main aim was to investigate where patients with co-occurring physical diseases and mental disorders (psychotic spectrum or mood) in the health and social service system are identified most frequently before admission into psychiatry. The second aim was to compare the differences in the treatment routes taken by the patients before entry into psychiatric services in all the participating countries (Denmark, Germany, Japan, Nigeria and Switzerland).
On admission to a psychiatric service, patients diagnosed with schizophrenia, schizotypal or delusional disorders (International Classification of Diseases-10 (ICD-10) group F2) or mood (affective) disorders (ICD-10 group F3) and a co-morbid physical condition (cardiovascular disease, diabetes mellitus and overweight) were asked with which institutions or persons they had been in contact with in the previous 6 months.
Patients from Denmark, Germany and Switzerland with mental disorders had almost the same contact pattern. Their primary contact was to public or private psychiatry, with a contact percentage of 46%-91%; in addition, general practice was a common contact, with a margin of 41%-93%. Similar tendencies are seen in Japan despite the small sample size. With regard to general practice, this is also the case with Nigerian patients. However, religious guidance or healing was rarely sought by patients in Europe and Japan, while in Nigeria about 80% of patients with mental disorders had contacted this type of service.
Promoting prophylactic work between psychiatry and the general practice sector may be beneficial in diminishing physical conditions such as cardiovascular disease, diabetes mellitus and overweight in patients with mental disorders in European countries and Japan. In Nigeria (a low-to-middle-income country), religious guides or healers, along with general practitioners, are the most frequently contacted, and they therefore seem to be the most obvious partner to collaborate with.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
66Psychiatry Clin. Neurosci. 2015 Sep 69: 587-95
PMID25708877
TitleDifferences in vulnerability to traumatic stress among patients with psychiatric disorders: One-year follow-up study after the Great East Japan Earthquake.
AbstractThe aim of this study was to evaluate differences in vulnerability to traumatic stress and the 1-year course of post-traumatic stress symptoms among patients with pre-existing psychiatric disorders after the Great East Japan Earthquake.
The Impact of Event Scale-Revised (IES-R) was used to assess post-traumatic stress symptoms in 612 patients with schizophrenic (ICD-10 F2; n?=?163), mood (F3; n?=?299), or neurotic disorders (F4; n?=?150) at 1-4 months and again at 13-16 months after the disaster (retention rate: 68%).
The mean IES-R total score for all diagnostic groups was 18.6 at index and 13.4 at follow up. The mean IES-R total score for patients with neurotic disorders (22.5) was significantly higher than that of patients with mood disorders (18.1) and schizophrenic disorders (15.9). At follow up, these scores decreased for all groups and inter-group differences were not observed.
Vulnerability to traumatic stress after a disaster was most severe in patients with neurotic disorders, followed by mood disorders, and, lastly, schizophrenic disorders. This difference among the three diagnostic groups was not found 1 year after the disaster.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
67Psychiatry Res 2016 May 239: 253-8
PMID27039009
TitleAssociations of acoustically measured tongue/jaw movements and portion of time speaking with negative symptom severity in patients with schizophrenia in Italy and the United States.
AbstractThis is the first cross-language study of the effect of schizophrenia on speech as measured by analyzing phonetic parameters with sound spectrography. We hypothesized that reduced variability in pitch and formants would be correlated with negative symptom severity in two samples of patients with schizophrenia, one from Italy, and one from the United States. Audio recordings of spontaneous speech were available from 40 patients. From each speech sample, a file of F0 (pitch) and formant values (F1 and F2, resonance bands indicating the moment-by-moment shape of the oral cavity), and the portion of the recording in which there was speaking ("fraction voiced," FV), was created. Correlations between variability in the phonetic indices and negative symptom severity were tested and further examined using regression analyses. Meaningful negative correlations between Scale for the Assessment of Negative Symptoms (SANS) total score and standard deviation (SD) of F2, as well as variability in pitch (SD F0) were observed in the Italian sample. We also found meaningful associations of SANS affective flattening and SANS alogia with SD F0, and of SANS avolition/apathy and SD F2 in the Italian sample. In both samples, FV was meaningfully correlated with SANS total score, avolition/apathy, and anhedonia/asociality.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
68J Clin Psychiatry 2016 May 77: 628-34
PMID27035871
TitleClozapine and risperidone in moderately refractory schizophrenia: a 6-month randomized double-blind comparison.
AbstractClozapine remains the only medication indicated for refractory schizophrenia. As new antipsychotic drugs become available, their efficacy compared to clozapine, particularly in moderately ill patients, is of great clinical interest. We compared risperidone, the first of these, to clozapine in partially responsive patients. Further, since participation of patients usually excluded from clinical trials is increasingly important, we broadened inclusion to a wider patient population.
We compared clozapine (n = 53) to risperidone (n = 54) in a randomized, double-blind, 29-week trial in schizophrenia patients (diagnosed using DSM-IV) at 3 research outpatient clinics. Randomization was stratified by "narrow" or "broad" inclusion criteria. The study was conducted between December 1995 and October 1999. Time to treatment discontinuation for lack of efficacy and time to 20% improvement in the Brief Psychiatric Rating Scale psychotic symptom cluster were the primary outcome measures.
There were no differences in all-cause discontinuation; clozapine-treated participants were significantly less likely to discontinue for lack of efficacy (15%) than risperidone-treated participants (38%) (Wilcoxon ?(2)1 = 6.10, P = .01). Clozapine resulted in significantly more global improvement (F2,839 = 6.07, P < .01) and asociality improvement (F2,315 = 6.64, P < .01) than risperidone. There was no difference in proportions meeting an a priori criterion of psychosis improvement (risperidone: 57%; clozapine: 71%). Significant adverse effect differences in salivation (F1 = 4.05, P < .05) (F1 = 12.13, P < .001), sweating (F1 = 5.07, P < .05), and tachycardia (F1 = 6.51, P < .05) favored risperidone.
Clozapine-treated partially responsive patients were less likely to discontinue treatment for lack of efficacy and improved more globally than those treated with risperidone, although psychotic symptoms did not differ. These findings suggest that clozapine should not be restricted to the most severely ill, treatment-refractory patients; it should be considered as an alternative for patients who have some response to other antipsychotics, but still experience troubling symptoms.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
69Eur. Psychiatry 2016 Mar 33: 54-60
PMID26866874
TitleExploratory study of once-daily transcranial direct current stimulation (tDCS) as a treatment for auditory hallucinations in schizophrenia.
AbstractAuditory hallucinations are resistant to pharmacotherapy in about 25% of adults with schizophrenia. Treatment with noninvasive brain stimulation would provide a welcomed additional tool for the clinical management of auditory hallucinations. A recent study found a significant reduction in auditory hallucinations in people with schizophrenia after five days of twice-daily transcranial direct current stimulation (tDCS) that simultaneously targeted left dorsolateral prefrontal cortex and left temporo-parietal cortex.
We hypothesized that once-daily tDCS with stimulation electrodes over left frontal and temporo-parietal areas reduces auditory hallucinations in patients with schizophrenia.
We performed a randomized, double-blind, sham-controlled study that evaluated five days of daily tDCS of the same cortical targets in 26 outpatients with schizophrenia and schizoaffective disorder with auditory hallucinations.
We found a significant reduction in auditory hallucinations measured by the Auditory Hallucination Rating Scale (F2,50=12.22, P<0.0001) that was not specific to the treatment group (F2,48=0.43, P=0.65). No significant change of overall schizophrenia symptom severity measured by the Positive and Negative Syndrome Scale was observed.
The lack of efficacy of tDCS for treatment of auditory hallucinations and the pronounced response in the sham-treated group in this study contrasts with the previous finding and demonstrates the need for further optimization and evaluation of noninvasive brain stimulation strategies. In particular, higher cumulative doses and higher treatment frequencies of tDCS together with strategies to reduce placebo responses should be investigated. Additionally, consideration of more targeted stimulation to engage specific deficits in temporal organization of brain activity in patients with auditory hallucinations may be warranted.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
70J Psychiatr Res 2016 Jan 72: 43-50
PMID26540403
TitleNod-like receptor pyrin containing 3 (NLRP3) in the post-mortem frontal cortex from patients with bipolar disorder: A potential mediator between mitochondria and immune-activation.
AbstractMitochondrial complex I dysfunction, oxidative stress and immune-activation are consistently reported in bipolar disorder (BD). Mitochondrial production of reactive oxygen species was recently linked to activation of an inflammatory redox sensor, the nod-like receptor family pyrin domain-containing 3 (NLRP3). Upon its activation, NLRP3 recruits apoptosis-associated speck-like protein (ASC) and caspase-1 to form the NLRP3-inflammasome, activating IL-1?. This study aimed to examine if immune-activation may be a downstream target of complex I dysfunction through the NLRP3-inflammasome in BD. Post-mortem frontal cortex from patients with BD (N = 9), schizophrenia (N = 10), and non-psychiatric controls (N = 9) were donated from the Harvard Brain Tissue Resource Center. Levels of NLRP3, ASC and caspase-1 were measured by western blotting, ELISA and Luminex. While we found no effects of age, sex or post-mortem delay, lower levels of complex I (F2,25 = 3.46, p < 0.05) and NDUFS7, a subunit of complex I (F2,25 = 4.13, p < 0.05), were found in patients with BD. Mitochondrial NLRP3 (F2,25 = 3.86, p < 0.05) and ASC (F2,25 = 4.61, p < 0.05) levels were higher in patients with BD. However, levels of caspase 1 (F2,25 = 4.13, p < 0.05 for both), IL-1? (F2,25 = 7.05, p < 0.01), IL-6 (F2,25 = 5.48, p < 0.05), TNF? (F2,25 = 7.14, p < 0.01) and IL-10 (F2,25 = 5.02, p < 0.05) were increased in both BD and schizophrenia. These findings suggest that immune-activation in the frontal cortex may occur both in patients with BD and schizophrenia, while complex I dysfunction and NLRP3-inflammasome activation may be more specific to BD.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
71Eur. J. Pediatr. 2016 Feb 175: 221-8
PMID26319008
TitleCross-sectional study to evaluate the longitudinal development of child and adolescent psychiatric diagnoses of inpatients in Vorarlberg, Austria.
AbstractClinical experience has repeatedly shown evidence for continuity between mental disorders in children and adolescents and mental disorders in adulthood. Up to now, Austria has had no epidemiologic data on psychiatric diseases in children and adolescents and their development into adulthood. How often do children and adolescents with psychiatric diseases have psychiatric diseases in adulthood? Is there any association between psychiatric diagnoses in childhood/adolescence and adulthood? Electronic medical records provided us with data on 2210 children and adolescents who were admitted to any hospital in the State of Vorarlberg, Austria, between 1997 and 2012 because of psychiatric diseases. In this cross-sectional study, diagnoses were coded according to ICD-10 and ICD-9 criteria. The three main reasons for admission of children and adolescents were substance abuse, emotional disorders and conduct disorders. Of the admitted children and adolescents, 9.8 % were readmitted to a psychiatric institution in adulthood. The main reason for readmission in adulthood appears to be disorders due to psychoactive substances (42.1 %). Of young patients with psychoactive substance use, 9.7 % were rehospitalized in adulthood, 70.8 % of them showed a diagnosis in the same category (F1) on admission. Children and adolescents admitted for schizophrenia, schizotypal, and delusional disorders (F2) were significantly more likely to be readmitted in adulthood (40.9 %) compared to any other child psychiatric diagnosis.
This study once again shows the continuity of psychiatric disorders from childhood and adolescence to adulthood. It also gives further information about the transmission of diagnoses when patients reached the age of 18 years and their outcome.
Until now, there is hardly any information about the outcome of children and adolescents with psychiatric diagnoses in Austria.
We want to bring up more knowledge on that issue. Research findings may improve prevention and clinical assessment of children and adolescents with mental health problems.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
72Eur. J. Pediatr. 2016 Feb 175: 221-8
PMID26319008
TitleCross-sectional study to evaluate the longitudinal development of child and adolescent psychiatric diagnoses of inpatients in Vorarlberg, Austria.
AbstractClinical experience has repeatedly shown evidence for continuity between mental disorders in children and adolescents and mental disorders in adulthood. Up to now, Austria has had no epidemiologic data on psychiatric diseases in children and adolescents and their development into adulthood. How often do children and adolescents with psychiatric diseases have psychiatric diseases in adulthood? Is there any association between psychiatric diagnoses in childhood/adolescence and adulthood? Electronic medical records provided us with data on 2210 children and adolescents who were admitted to any hospital in the State of Vorarlberg, Austria, between 1997 and 2012 because of psychiatric diseases. In this cross-sectional study, diagnoses were coded according to ICD-10 and ICD-9 criteria. The three main reasons for admission of children and adolescents were substance abuse, emotional disorders and conduct disorders. Of the admitted children and adolescents, 9.8 % were readmitted to a psychiatric institution in adulthood. The main reason for readmission in adulthood appears to be disorders due to psychoactive substances (42.1 %). Of young patients with psychoactive substance use, 9.7 % were rehospitalized in adulthood, 70.8 % of them showed a diagnosis in the same category (F1) on admission. Children and adolescents admitted for schizophrenia, schizotypal, and delusional disorders (F2) were significantly more likely to be readmitted in adulthood (40.9 %) compared to any other child psychiatric diagnosis.
This study once again shows the continuity of psychiatric disorders from childhood and adolescence to adulthood. It also gives further information about the transmission of diagnoses when patients reached the age of 18 years and their outcome.
Until now, there is hardly any information about the outcome of children and adolescents with psychiatric diagnoses in Austria.
We want to bring up more knowledge on that issue. Research findings may improve prevention and clinical assessment of children and adolescents with mental health problems.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal
73Neuropsychopharmacology 2016 Jan 41: 477-86
PMID26068729
TitleSchizophrenia-Like Phenotype Inherited by the F2 Generation of a Gestational Disruption Model of Schizophrenia.
AbstractBoth environmental and genetic factors contribute to schizophrenia; however, the exact etiology of this disorder is not known. Animal models are utilized to better understand the mechanisms associated with neuropsychiatric diseases, including schizophrenia. One of these involves gestational administration of methylazoxymethanol acetate (MAM) to induce a developmental disruption, which in turn produces a schizophrenia-like phenotype in post-pubertal rats. The mechanisms by which MAM produces this phenotype are not clear; however, we now demonstrate that MAM induces differential DNA methylation, which may be heritable. Here we demonstrate that a subset of both second (F2) and third (F3) filial generations of MAM-treated rats displays a schizophrenia-like phenotype and hypermethylation of the transcription factor, Sp5. Specifically, ventral tegmental area of dopamine neuron activity was examined using electrophysiology as a correlate for the dopamine hyperfunction thought to underlie psychosis in patients. Interestingly, only a subset of F2 and F3 MAM rats exhibited increases in dopamine neuron population activity, indicating that this may be a unique model with a susceptibility to develop a schizophrenia-like phenotype. An increase in dopamine system function in rodent models has been previously associated with decreases in hippocampal GABAergic transmission. In line with these observations, we found a significant correlation between hippocampal parvalbumin expression and dopamine neuron activity in F2 rats. These data therefore provide evidence that offspring born from MAM-treated rats possess a susceptibility to develop aspects of a schizophrenia-like phenotype and may provide a useful tool to investigate gene-environment interactions.
SCZ Keywordsschizophrenia, schizophrenic, schizophrenics, schizotypal